How can healthcare providers improve process flow and work burdens?
Lean principles can be especially effective in reducing task burden; therefore improving care quality and mitigating risk of burnout.
Lean interventions often start with the principles of 5S — sort, set-in-order, shine, standardize, and sustain, expanded as follows:
- Remove what isn’t needed by separating necessary supplies and processes from the unnecessary.
- Identify and organize the remaining necessary supplies, equipment, and processes.
- Conduct regular so-called cleaning of the physical environment and tuning of processes to keep the work area organized and safe.
- Create a standardized schedule for regular process shining and maintenance by following the sort, set-in-order, and shine methods.
- Make 5S a part of your organization’s mission by following the first four methods.
By organizing the real and virtual — for example, the InBasket — workplace, staff can declutter materials and processes, and reduce time wasted in searching, waiting, and over-documenting.
Beyond 5S, the standard suite of lean principles also form the centerpiece of team-based care.
Strategy deployment
Everyone, from the executives to frontline teams, is clearly organized around the must-do, can’t fail initiatives, which are visible and present, and tracked in all meetings daily.
Standard work
Each team member should have standard work that sets up other team members with standard handoffs and protocols that speed the flow of information.
Flow
Improving flow can help reduce the cognitive burden and incessant choice-making that fuels burnout.
Rather than batching a cache of activities at the end of the day, everyone in the practice should take on bits of work throughout the day.
By moving from batched work into flow, providers make best use of their skills — and their team’s skills. They have more energy and focus for what they’re trained to do, which offers greater fulfillment, engagement, and joy in work, infusing energy and commitment back into daily work.
External setup
Standardize the setup process for patient visits so staff can more efficiently receive information around patient histories, documents, review of systems, care gaps, standing orders, and procedures.
This effort includes teaming up on clerical processes to standardize and manage them by protocols, so providers just add a signature or bits of clinical information. This team-based management of clerical tasks can hopefully lead to automation of clerical tasks as the future unfolds.
With external setup, transitions and handoffs can become smoother and fewer errors are introduced.
Leveling, team-based care
Promote skill-task alignment, which matches the right person and certification to the right task.
Electronic health record (EHR) improvements reduce burnout additionally and can be accomplished using 5S methods and lean principles that take documentation from batch to flow. In an evolved and redesigned team, task load can decrease, documentation is shared and leveled across the team, as are results reporting and inbox messages.
In lean redesigns, people at the point of care decide what task burdens to reduce by elimination and spreading tasks across the team. This counters the EHR’s architecture, which concentrates tasks on the provider. Lean harnesses the experience and creativity of the people who do the work to align tasks to each team member’s skills and reduce time and task burdens.
Social network theories and studies in provider groups suggest that friendship and patient-sharing ties drive clinical quality improvements, adoption of EHRs, and evidence-based care better than hierarchical exhortations and mandates. Developing the guiding coalitions that harness social networks and management structures can help ingrain quality improvement into daily work.
