Monday, March 8, 2010

Participating in my hospital's Lean quality improvement retreat

I'm very, very honored to be indulging this week in a new form of "patient engagement": I'm participating in the annual "Lean" quality improvement retreat at my hospital, Boston's Beth Israel Deaconess Medical Center.

In the workshop with me are about 20 BID staffers - mostly residents, some nurses and other staff. Having been on the receiving end of care in seven admissions during my near-fatal 2007 illness, it's an honor to be behind the scenes now and helping work on the continuous improvement that's a hallmark of Lean.

Here's the team leading the workshop, from the hospital's Business Transformation team. From left: Jenine Davignon, Kim Eng, Julius Yang, Bonnie Baker, Alice Lee, Anjala Tess.

"Lean" is the methodology that's transformed many industries in recent decades. It's about identifying what you do that creates value for your customer - as defined by the customer - and eliminating everything you do that's not that. Marvelously, when you follow this method, not only does quality go up but costs go down, and things tend to get done faster, too - a pretty slick combination.

Hospital CEO Paul Levy has written often on his blog about how they've been applying Lean methods for five years. A recent example is here. In this workshop we're all learning about the Lean approach, and even on our first day we applied it by "going to gemba," the place where work happens.

Our homework is from the book Lean Hospitals by Mark Graban of the Lean Enterprise Institute in Cambridge. He was the guest lecturer during today's working lunch.

The focus of our workshop this week is the hospital discharge process. I never would have known it's such a big deal, but it turns out nationwide 20% of all patients discharged from hospitals are readmitted within a month - and Beth Israel Deaconess is a bit worse than that. So we'll be looking at all the various factors that might contribute to unsuccessful handoffs, and how process improvements might help.

This place has some success with Lean. One of the first big initiatives was to reduce the rate of central line infections. In January Paul announced that the infection rate per 1,000 patient days has dropped 83%. To me this is a big deal because:

  • 25% of central line infections lead to death
  • During my treatment in 2007, I had four central lines put in, for a total of 28 days.
The hospital is open about this process - openly disclosing their failure rates and progress: (CL-BSI is central line blood stream infection.)

So before my admission I'd read all about this initiative, and I was able to chat about it with the surgeons each time they did it to me. And I was, like, really glad they'd undertaken this Lean improvement before my time came.

That kind of openness is only possible if you're committed to improvement, more than anything else.

That's part of why I'm honored and thrilled to be part of their next Lean workshop. So much in healthcare needs improving, and here we are, actively at work on making caregivers' jobs more effective.

Next post in the series here


  1. e-Patient Dave,
    Thank you again for a wonderful blog.
    I've been hearing more about "lean" hospitalization. At first I wondered if 'lean' meant cutting back on the actual care, but have sure learned differently.
    Although we work in statistics here, we are very involved with the hands on approach to our patients.
    I look forward to reading more about the Lean Workshop!

  2. Interesting post you've got out here. I am hoping that what you've initiated could in time succeed for the sake of preventing he rate of central line infections. Keep it up and more power. Good Luck!


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