Medical Staff Engagement & Lean Management

Diane Bissenden

Director, Population and Family HealthVancouver Coastal Health – Richmond

Dr. Brenda WagnerChair, Richmond Medical Advisory Committee

Clinical Associate Professor, Obstetrics & Gynaecology University of British Columbia

Laura Sato

Coordinator, Lean Transformation Services

Vancouver Coastal Health

February 28th, 2013

Burning Platform

How do you engage medical staff in yet another administrative process to drive patient safety and quality improvement?

How do you ensure sustained medical staff engagement in system redesign that is based on Lean principles?

Medical Staff Engagement: Current State

Initial StateInitial State:

• Medical staff disengagement as have lived through multiple administrative change efforts

• Improvements have been ‘tried before’ and not sustainable

• Long standing issues that have not been resolved and people didn’t believe the issues could be changed

Feedback from Medical Feedback from Medical StaffStaff

• “There is lack of physician engagement”

• “Management should make the changes and leave us alone”

• “Everyone else around the table is paid for being here except for physicians”

Medical Staff Engagement: Ideal State

Ideal StateIdeal State:• Medical staff engagement in

Lean as a unique and successful change management process

• Improvements are sustainable

• Long standing issues are resolved and medical staff believe they are part of the change

Target State:• One medical staff

member from each relevant discipline will engage in the process i.e. family practice, midwifery, obstetrics, paediatrics, and anaesthesia

• Process inspires ongoing engagement

Birth Centre Initiative: Goals and Area of Focus

Birth Centre Initiative: Deliverables

• Increase capacity to do Caesarean Births and recovery in the Birth Centre

• Build processes to manage surges

• Provide timely outpatient services– Triage, assessment, non-stress tests &

inductions of labour, etc.

• Standardize processes from decision to Caesarean Birth

Birth Centre Initiative: Engagement of People

• Medical StaffMedical Staff– Obstetricians– Family Physicians– Paediatricians– Midwives– Anaesthesiologists

• Nursing StaffNursing Staff– OR/ PACU/ Birth

Centre/ NICU/ Staff Support Coordinators

• Allied Health StaffAllied Health Staff– Respiratory

Therapists, Social Work, Laboratory Services

• Support ServicesSupport Services– Housekeeping, Unit

Aides, Sterile Processing Aides, Unit Clerks, Medical Office Assistants

Medical Staff Engagement Strategies

• Physician co-sponsor on the team• Funding for medical staff time spent in Lean initiatives• Off site obstetrician & anaesthesiologist meeting on Code

Pink & Skin to Skin in Operating Room• Ad-hoc meetings during down times with on-call medical

staff (end of the day)• Hallway conversations (1:1)• Feedback obtained during

observations (1:1)

Medical Staff Engagement Strategies

• Arrange Working Group Meetings around medical staff schedules: – Lunch times & end of the day– Organize meeting agendas so physicians can attend at times

when their key issues will be highlighted• Mixture of 2 hour, full day & ½ day workshops

• Piggyback on existing medical staff meetings• Provide ample notice for meeting invitations• Invite medical staff in person• Invite on-call medical staff

Medical Staff Engagement in Lean Management

• Process improvements occurring in tandem with Lean Management– Using Lean Management approach based on

ThedaCare Model– Three physicians attended Lean Management

education• Applying Lean principles to clinical office setting• Organization investing in physician education in

order to support improved patient care• Physicians feel part of the team

Lean in Action:What is Code Pink ?

Code Pink: Standard WorkOB (co-pilot)-Provides direction to the team-Verbal consent & explanation-Primary RN gives report-Site mark?

Anaesthesiologist (co-pilot)-Greets pt-?who can get the meds the quickest-Check equipment-Receive report from OB

Paediatrician-Prep for baby resuscitation-Double check ICC-Primary RN gives report

Birth Centre Initiative:Code Pink Mock Session

Initial Mock Post - Actual Code Pink

Noisy – lots of talking Calm & quiet

Repeating questions multiple times Staff know what to do

Duplicated work- # of people doing the same thing

Roles and responsibility clarity

Lots of double checking Trusting environment

Too many people in the room

Medical Staff TestimonialsKeeping mothers and babies together after birthKeeping mothers and babies together after birth encouraged me to participate

I have been “blown away” by the improvements during the past year

“…..If you want to show us this is different, fix the problem no one has

been able to fix in 20 years - emergency caesareans”. This

physician now states with enthusiasm that LEAN is making a

big difference and we are being successful.

Doctors see the satisfaction their patients

and babies are kept together. This satisfaction

is encouraging the doctors.

Best thing was seeing the capacity we have within our frontline staff to make changes

happen. This is the power I see Lean harnessing that I have never seen harnessed before.

Sessional payments are helpful and meaningful

Birth Centre OutcomesIndicator Baseline % Target ∆ Outcome ∆

Reduce the Birth Centre OR Turnaround time

3:30 h ↓ by 50% 1:30 h (138%↓)

% of Caesarean Births done in BC OR

27% ↑ by 50% 75% (185%↑)

Code Pink Response Time (Decision to Baby born)

30~ minutes 18 minutes* (↓ 40%)

Medical Staff Engagement

4 per engagement opportunity

↑by 200% 400%

*30 day data

Reasons for Success

• Strong physician, director & manager leadership• Strong relationship between medical staff and

clinical resource nurse (over 20 yrs)• Operational and medical staff leadership “Walk

the Talk”• Engaged and stable team (low turnover)• Project leadership share successes• Organizational commitment in form of individuals

with expertise in lean thinking

Operational Sponsor’s Experience

• Setting the stage at the beginning of every session, no matter where you are in the process

• Simple is usually complex• Don’t get discouraged when things get “messy” – trust

the process• Medical staff participation in all aspects of the Birth

Centre quality improvement initiative adds value and strengthens team relationships

• Deeper level of engagement and pride in the change, through doing together

• Continuous improvement is embedded in the culture of the Birth Centre

Physician Sponsor’s Experience

• Be flexible with meeting times• Invite people personally• Sometimes a different venue can overcome obstacles• Projects identified by frontline staff as “unfixable” will

convert the hard of heart• Practice, Practice, Practice

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