Standardization of Clinical Processes
with LEAN for 4 Eye Surgeons:
Finding Unity in the Eye of the Storm
Julia R. Spankowski and Gregory J. Stacey
Lean Six Sigma Black Belts / Froedtert Health
Froedtert Health
•
Academic medical
hospital partnered with
the Medical College of
Wisconsin
•
3 Hospitals
•
Over 20 clinics and
surgery centers
•
Nationally ranked
•
Southeastern Wisconsin
is the primary coverage
area
Approach:
A3 Problem Solving
Define the
Problem
1
Understand
Current
State
2
Complete
Target
Setting
3
Root Cause
Analysis
4
Determine
Solution
Approach
5
Rapid
Experiments
6
Develop a
Completion
Plan
7
Confirm
Results
8
Reflect on
Insights
9
Problem Definition
In the past year there were 4
errors that either resulted in a
wrong lens implant and/or
patient safety issues in the
cataract process from errors
that were discovered by staff
or patient follow-up.
Cataract video
Current State
Temporary Containment
•
New process for documenting
lens changes
•
OR schedule documentation
•
Implementation of a 2
nd
timeout
for lens changes in the operating
room
Current State
Key Observation
4 providers + 4 processes = Greater opportunity
for patient safety errors
Target State
•
No patient safety errors
•
Single standardized process with specific
criteria for exception processes
Team Development Stages
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• Team acquaints • Ground rules
established • Members are like
strangers
Forming
• Clarity of purpose • Members feel like
individuals • Conflicts start
Storming
• Feel like a team • Goals can be met
through compromise • Clear roles
Norming
• Clear vision and purpose
• Members are open and trusting • Flexibility is key Performing • Task completion • Good feelings • Recognition of team Adjourning
Change Management Scenario
Background
•
4 Providers each believing their process is the best
•
Team is in storming phase
•
Unclear on who is making them change
•
First time solving problem as a team
•
Providers have their own practice no direct authority
Question
What approach would you have taken to move the team past
the “Storming Phase”?
Change Management Scenario
Our Approach
•
Clearly defined sponsor and champion
–
Sign off on Charter
(Formal Leadership commitment not received on the A3)
»
Head of Cataract Surgery, Chair of Dept., VP of Quality
–
Sponsor Report-outs
»
Sharing expectations and check-in
•
Remained neutral and let them get out concerns
–
Facilitators- Did not give directives, wanted team to realize
they needed to work together to fix process
Root Cause Analysis
Staff available to
do A’s and K’s
during patient
visit otherwise
map alternative
Should there be
same day lens
selection?
Multiple Handoffs
1
2
3
4
6
Determine Solution Approach
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Conduct a 30-60-90
Day Review
M etric
C urrent
State
F uture State
30 day
4/ 10/ 15
60 day
5/ 08/ 15
90 day
6/ 10/ 15
Wrong Lens Implants
3 in recent year
0 per year
0
0
0
Tech availability for IOLs
Not measured
95%
100%
100%
99%
Reduction in Wasted IOLS in OR
2.25 per month
1 per month
0
0
2
Near Misses in OR
0 per year
0
0
0
Change Management Scenario
Background
•
In the Confirmed Results process checks, it was observed
one provider specifically was not consistently following the
new standard process.
•
This provider is an amazing and high volume surgeon.
Question
How would you handle this at the 30, 60, 90 day checkpoints
to make sure this does not continue?
Change Management Scenario
Our Approach
– Our Approach
• 30 day give process more time
• 60 day sent out friendly email reminder pointing out specific
offenses
• 90 day one on one, working to set up Cataract Team
meeting/huddle frequency
Key Insights
What went well?
Staff is now working better as a cohesive team
Structured PDCA methodology
What helped?
Using an outside resource (LSS Black Belts) to challenge the team
What didn’t go well?
Difficulty moving past preconceived notions
Lessons Learned
Allowing the team time to storm was critical in
Reflect on
Thank you!
