Lean program delivers at Sierra Vista Regional Medical Center

Start with a premise. A more engaged employee is a happier employee – leading to higher employee satisfaction, which will lead to higher physician satisfaction and ultimately result in higher patient satisfaction. If 2015 is any barometer, Sierra Vista Regional Medical Center in San Luis Obispo, California, proved the theory correct.

Sierra Vista Regional Medical Center launched a program known as Lean Daily Management (LDM) in October 2014, and by most metrics it has been a rousing success.

LDM—originated by and derived from the Japanese manufacturing industry decades ago, and adopted by the healthcare industry in recent years—is a methodology that allows for quick change in process when efficiency is challenged. Its overriding goal is to improve patient care, quality and outcomes. The basic core of Lean is to give staff the analytical tools and strategies they need to identify and resolve issues. It is a disciplined process that empowers staff to solve problems by giving them the resources and leadership support to make improvements.

A couple of years ago the leaders at Sierra Vista identified a need to engage staff in an effort to spur performance improvement. Leadership surmised that across-the-board improvement required the active involvement of staff in identifying issues and suggesting solutions. The idea was to achieve a non-punitive culture of "speaking up" and implementing proposals to improve processes. This, in turn, management theorized, would provide a hospital-wide focus on any barriers that potentially impeded the staff's ability to provide safe, high-quality care to patients. It was decided to implement Lean and its goals:

• Empower staff at all levels of the hospital to recognize and solve problems
• Gather data and assess performance measures on a daily basis
• Address issues in real time, and
• Focus on sustainable solutions and outcomes.

"Rather than trying to figure out how things should change by sitting in a board room, Lean empowers front-line staff to take ownership of the solution," says Joseph DeSchryver, Sierra Vista Chief Executive Officer. "Leadership's role is to monitor the results and remove any barriers that may be hindering improvement."

Front-line staff was provided with three days of intensive Lean training. Their charge? Develop key performance indicators (KPIs), relevant to their department, that will remove barriers and make their processes more efficient. No metrics were dictated by Administration. Rather each department was asked to organically discuss issues among themselves and develop the relevant number of metrics that would be helpful to their work.

So, how exactly does the Lean program work? Key to the program is a daily Safety Huddle that takes place in the hospital's Administrative Conference Room and lasts about 20 minutes. Any staff member can attend, but it is mandatory for those in leadership positions. Physicians (particularly hospitalists and ER doctors) are encouraged to attend as their schedules allow. In this meeting, team members review and discuss hospital census, safety concerns and service recovery opportunities, in addition to celebrating "great catches" that move Sierra Vista even further toward being a top hospital in the nation. Every member of the senior leadership team has committed to not schedule meetings between 8:30-10 each morning and they devote their full attention to the Safety Huddle and subsequent Gemba walk and debrief session.

Following the Safety Huddle is the "glass wall" segment—a discussion of things that prevent staff from doing their jobs more effectively. Its goal is to support and organize problem-solving as well as quality and safety improvement efforts.

Other segments include follow-up debriefings about problems and potential roadblocks that have been identified and addressed, and director coaching designed to help staff solve problems and to ensure accountability.

Thus far, the results have been very impressive. The definition of a Lean "win" is a measurable improvement that is the result of communication, education, increased awareness or, ideally, a sustained process change. Lean has produced more than 50 wins since its implementation. Performance metrics show improvement in such areas as quality, cost, service, and patient and employee satisfaction. The numbers speak for themselves:

• 76% improvement in identifying missing equipment that could delay the start of surgery
• 63% improvement in medication deliveries
• 63% improvement in documented radiology exams before they are read by a radiologist
• 87% improvement in on-time starts for the first surgical cases of the day
• 86% improvement in on-time starts for outpatient radiology cases
• 67% improvement in readiness of patient rooms
• 40% improvement in processing time of lab work in the Emergency Department.

Sierra Vista reports that Lean's success has exceeded all expectations. Employee satisfaction has increased by 8% and patient satisfaction also has improved.

"The results have been most gratifying," adds DeSchryver. "What we have proven to date is that by asking the right questions we are able to improve processes, reduce costs, improve interdepartmental communication, and implement changes that make workflow better. This collaboration makes a positive difference in patient care and satisfaction. Implementing Lean is designed to help us reach our goal of being the premier provider of healthcare services on the Central Coast."

Sierra Vista Regional Medical Center, located on California's Central Coast, is a 164-bed acute care provider of tertiary services with nearly 800 employees, and more than 400 medical staff. We can be reached at 805-546-7600 or through our website at www.sierravistaregional.com.

Kim Brown Sims, RN
Chief Nursing Officer
Sierra Vista Regional Medical Center
San Luis Obispo, CA
(805) 546-7687

Ron Yukelson
Associate Administrator, Business Development
Sierra Vista Regional Medical Center
San Luis Obispo, CA
(805) 546-7925

Nick Wettlaufer
Lean Manager
Sierra Vista Regional Medical Center
San Luis Obispo, CA
(805) 546-7888

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