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Using Value Stream Management to Better Care for Stroke Patients

by Lori Smith
April 23, 2015

Using Value Stream Management to Better Care for Stroke Patients

by Lori Smith
April 23, 2015 | Comments (0)

Value Stream Management brings more value to the customer or client by working to transform both process and people. At my organization INTEGRIS, structurally-speaking, value stream management helps us manage multiplestreams of patient care delivery and other supporting business systems. 

But to make value stream management really work, the most significant cause for transformation lay simply in the shifting of team members’ mindsets. It’s been a long process, but over the past 5 years INTEGRIS has slowly developed a new Stroke Value Stream Management System comprised of functional team units working together to continuously improve the quality of care of stroke patients and their families.

We’re on our 11th revision with 7 distinct component parts mapped:

  • Preventive education
  • Community-based care using tele-stroke
  • ED
  • ICU
  • Stroke Unit
  • Rehabilitation
  • Post-follow up care and support

We at INTEGRIS have made improvements to work processes through what we call integrated care teams that manage the various horizontal patient experiences and process flows. Using this approach, we’ve been able to achieve the following:

  • deeper knowledge and understanding in specific patient populations
  • achievement of higher levels of service excellence
  • continuous improvement of care coordination and transition management
  • a much better understanding of the patient’s perspective of value-added experiences
  • improved coordination of patient care through a team dedicated to horizontal problem-solving

During these years, as a result of INTEGRIS’s efforts to think across all patient experiences and process flows, the team has had major mindset shifts. As a coach, I’ve asked people to tell me more about how exactly their thinking has changed over time and here’s what a few people have said:

“When we I looked at the whole flow on the value stream, I had to come out of my own 'piece' of the patients experience before I could 'truly see' how each 'piece' effects everyone else. It really demonstrated just how integrated we really have to be to deliver high value to our patients.”

“’We didn’t know what we didn’t know’ was a shift for me. We always looked at things from a single perspective and in boxes and I never realized that a change in my area could potentially shift a lot more burden to another department that is caring for the same patient I am.”

"One of the most significant mind-sets shifts for me was when we converted one of our analytics regarding “door to drug” time to ‘neurons saved.’ It truly defined what we do much better than meeting a metric that we were required to meet. It became real when our Neurologist and our Medical Director sat in our team meeting and indicated that if we calculated that time by minutes, we need to think of it as ‘1 minute longer could destroy 1.9 million neurons.’ That woke us up.”

This is one of my favorite stories:

“From my view, it helps us to ‘truly see’ what we need to do to provide the best patient care. It becomes less about me “trying really hard” and more about a team that helps each other be successful even in the midst of our many moving parts.

For example, there was a time we were all doing “fairly well” within our own departments with our measures and the numbers looked good on paper regarding our “defect free” stroke care for the patient. But our mindset shifted dramatically when we actually started auditing horizontally within the patient record which included all of the transitions of care for the patient. We were quickly humbled when we discovered one defect occurrence, or more, in each functional department in the horizontal flow of the patient. We were not defect-free and that created a new way of calculating our defect-free measure. As time went on, we actively worked around the value stream on improvements rather than making incremental departmental improvements in one area that might not work for all. No matter how hard we worked on our ‘piece’ of the stream, we knew we couldn’t really feel successful unless all of our component parts were successful. Our thinking had changed. And we each feel much more connected to each other now as a result of working together around the map because we know and can clearly see that we are producing more value for patients and their families.”

Where We Are Today

The success of our model-line for stroke value stream management has allowed us to spread the structure, process design, and deployment for the cancer patient, pulmonary patient, surgical patient, and sepsis patient. It’s also helped us spread this work across the supply chain and now we are proud to share our story with others.

On a personal level, in my 27 years of healthcare experience, this has been the most meaningful and transformative work I’ve seen to achieve continuous improvement in both patient care delivery and other business systems.

The views expressed in this post do not necessarily represent the views or policies of The Lean Enterprise Institute.
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