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AAMC is getting Leaner – By Brian Baker, MD

by jhopp on February 27, 2013

As part of Vision 2020: Living Healthier Together, we’re looking for ways we can work smarter. Higher Quality, Lower Cost (HQLC), means enhancing our performance and eliminating waste, which allows us to grow. 

You may have heard new phrases being used such as “value stream analysis,” “rapid improvement event” and “Lean Transformation”. If you ever find yourself wondering what these terms mean or how they affect AAMC this is a great opportunity.

What is an RIE?

An RIE (rapid improvement event) is a weeklong event in which a specific process is analyzed with the goals of high quality, lower cost.  The RIE team meets each day and is comprised of process owners, individuals within the process, customers of the process, and fresh eyes.  It is important to get the right team around the table during an RIE, so during the week other individuals may be called in to ensure nothing is overlooked or to get more information.

The week begins Monday morning with a kick off meeting, in which teams are empowered by management to create change within the organization.  Afterwards the teams separate and begin to look at their specific problem, reviewing the reason for action, initial state and target state.  Once agreed upon the team moves on to process mapping the current, ideal, and future states.  Late Monday afternoon or Tuesday morning the team moves on to the Gap Analysis. The Gap Analysis is used to determine what is keeping the current state from the future state and leads directly in to the solutions approach – it can also be thought of as barriers to accomplishing the goal.  Once the team has reached the solutions approach they begin to discuss how to solve each gap.  During this discussion different ideas can be generated, so the team must use rapid experiments to determine their best course of action. After specific solutions have been tested the team determines how to implement them with a completion plan.  Once the solutions have been implemented a performance Improvement team member will return to the process to determine the confirmed state. The confirmed state is used to ensure the team has met their targets discussed in the beginning of the week.  Lastly, the team gives their insights for the week in which the team discusses what went well and what did not, so that the next RIE can be more successful.

What are the ideals of a Lean Transformation?

By targeting and eliminating waste in (1) transportation, (2) inventory, (3) motion, (4) waiting, (5) over-production, (6) over processing, (7) defects, and (8) un-used human potential the lean team increases productivity while decreasing cost.  In addition to eliminating waste, the team implements 6S ideals which are (1) Sort, (2) Straighten, (3) Scrub, (4) Standardize, (5) Sustain, and (6) Safety.  

Where we are now and where are we going?

Our Organization is currently involved in four value streams.  These value streams include the Pharmacy, Revenue Cycle, Perioperative, and Supply Chain.  In addition to these main areas the organization has implemented lean transformations in the lab, care management, and food services.  New target areas/processes are being discussed as the lean team grows and will include the ideal patient care unit.

The last round of RIEs has been in the Pharmacy, Supply Chain, and Perioperative VSAs.  The Pharmacy RIE focused on the procurement of medications.  While looking at this process the RIE team determined to implement a ‘kanban’ system for reordering and look at our current contracts.  The Supply Chain RIE was focused on analytics and utilization in order to establish a baseline of where we are now and a process for determining metrics in the future.  The Perioperative RIE took a look at the over-processing of instruments.  This included reconciling instruments into incomplete trays, and determining what instruments are still in used, or could be recycled/donated.

The upcoming round of RIEs will be focused on inventory management for the Pharmacy VSA, scheduling for the Revenue Cycle VSA, anesthesiology EMR for the Perioperative VSA, and value analysis for the Supply Chain VSA.