Are You Ahead or Behind? -- From Daily Struggle to Moving Forward Together
Located 10 miles from downtown Boston, the Lynn Community Health Center (LCHC) is in the economically, culturally, and socially diverse city of Lynn. A federally qualified health center, it serves more than 40,000 patients, who speak 72 different languages, and hail from 113 countries. More than 90% of them live at or below 200% of the federal poverty line.
When the center began its lean management journey in 2015, visits per provider had been declining for over five years. The annual budget had become hard to meet since a year with a 1% margin was considered a good. The journey had survived a leadership transition but now it faced a radical change as its payment model moved from volume to value-based. Virtually all positions were paid below market, a harbinger of high turnover. The governing body that determines federal funding, wrote in 2015 that “LCHC should take steps to improve clinical efficiency, particularly provider productivity (access to care) in order to improve the overall cost efficiency.” Re-designing the work was not a crucial issue, it was existential.
Since then, LCHC has worked to create a model primary care clinic powered by Lean Thinking. As a result, it is able to better serve its patients (and employees!) by tackling wait times and achieving increasingly higher levels of productivity. Early results produced a 40% decrease in patient visit?times?and it all started with one question: Are you ahead or behind?
LCHC also used visual management to study the long-standing productivity problem. The goal was to build a habit of gathering facts daily, reflection on them, then starting rapid-cycle experimentation focused on learning. The team achieved a 13% increase in volume across all primary care services resulting in a $1M surplus. Could visual management support the work of leaders? This work forced the senior leadership team to face its own reality and take the most difficult of steps -- personal commitment and volition must precede any meaningful organizational change.
Too often, leaders rely on monthly stats and quarterly reports to make important operational decisions that can drastically impact the front line. LCHC is shifting decision-making power to frontline leaders, who best know the changes needed to achieve excellence for patients and financial stability for the organization.