In the first value stream mapping session, the internal Lean coaches observe. In the second value stream mapping, they colead the whole three-day session, the 30-day report out, and the 60- and 90-day reports, working closely with the consultants. In the third value stream mapping, the Lean consultants have it pretty easy. They watch and provide some pointers, but it is the physician organization that does the work.
"Sometimes the best Lean coaches are the people who haven't had a background in quality improvement or process improvement previously," Leyden says. "It is based on their interest and desire and ability to effectively implement change." So far, Leyden says BCBS Michigan has spent about $2 million funding physician Lean programs in the past two years.
And what bang does the health insurer get for its buck.
"We get improved quality of care for our members, reduced readmissions," he says. "The better the physician organizations use their disease registries, the better care is delivered. Hopefully that results in less [emergency room] visits, in less patient stays, and things of that nature."
Despite its origins in the manufacturing sector, Millermaier believes Lean is a good fit in medicine.
"The principles of Lean can apply," he says. "None of the Lean consultants had a healthcare background when they started with us. They brought to us a perspective around business operations that is challenging for us in medicine, particularly for physician leaders. It is not an area that we are strongly trained in."
"Once you get past the notion of the widget manufacturers coming in to commoditize healthcare, it teaches us how to be more effective and efficient in what we are doing," Millermaier adds. "And it aligns very much with the Institute for Healthcare Improvement's Triple Aim when you look at optimizing the patient experience, improving the population's health, and keeping costs per capita under control."