Daily Kaizen

This post was written by Rupal Badani, an inspiring frontline physician leader at Palo Alto Medical Foundation.  She and the organization are starting some really exciting Lean transformation work and we are just trying to keep up.  Love it…

Of all the errands on our weekend to do list, my least favorite is grocery shopping. In fact, over the last 10 years, I have tried to go into the grocery store as seldom as possible. When I did, I felt lost – often searching for items, backtracking to aisles I had already walked down, and invariably forgetting something I needed.  Luckly,
my husband finds trips to the store enjoyable.
But, there was a recent stretch when circumstances led to me having to be the one to go to the store several times in a row. To my surprise, I found that the more I did it, the less averse I was to going back. And each time, I got a little better. It helped that all the Safeways near us are “standard” in their layout. So anywhere I go, the store seems surprisingly familiar. Armed with a pre-set list, ample time and set goals, I can actually do the trip efficiently, without wasted effort or errors,  and at the end of it all, feel like I accomplished something good for myself and my family. The errand that was fraught with inefficiency, frustration and stress, was now tolerable (at times, dare I say? enjoyable). The difference? Once I learned how to shop in flow, everything changed.

The same applies at work. In May, I had the pleasure of visiting Virginia Mason to
learn about LEAN and flow. After that trip, we began to pilot flow in the pediatrics department in Fremont. We started small. Just me and my medical assistant.
She became my flow manager – in charge of making sure we were staying on track,
smoothing the day and teeing up the work for me to do between patients. We
learned a lot.

We learned that I was doing a lot of work in the exam room that she could do. We
learned that if we huddled each morning, we could avoid many pitfalls (or, as
we like to call them – flowbusters!). We learned that agenda setting with every
patient everytime helps keep the team on track and meet the patient’s needs. We
learned that we needed to formalize the role of the RN in our departments and
officially bring together the entire care team (front desk patient service representative, medical assistant, nurse, physician) to work towards this goal
because staying in flow is a team effort. We learned sitting together facilitated easy communication and reduced frustration. On a personal note, I learned that though I still occasionally need a private space, it is seldom and not nearly as often as I thought I would.

In August we invited 3 additional medical assistant-physician teams to participate
in designing the role of the flow manager. Our 4 week pilot ended last week.
Feedback has been mostly positive and we are starting to get some interest from
other members in the department. Chart closure is improving. Medical
assistant-physician communication is improving. Everyone in the pilot sees the
efficiencies gained by working in this manner. None of the piloting physicians
wants to leave the workstation to return permanently to their office.

We still have a lot of questions with regards to spread across departments and
sites. We presented our initial findings to the model line team this week and
will be working to design and pilot this in the other primary care departments
next month. But I can tell you there have been several instances during the
pilot where I left work, with all my work done, before my MA (whose day ends 30
min after my last patient leaves). In fact, it has become a bit of a friendly
contest to see who can leave first! My workday, once fraught with stress,
frustration and inefficiency, is now enjoyable, efficient and with the waste
removed, i get to do what I like best – spend time with my patients. As with
shopping for groceries, once I learned to work in flow, everything changed.

Now if I can just figure out how to implement a two-bin kanban in my pantry….

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