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Health Services Research & Development

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2008 HSR&D National Meeting Abstract

National Meeting 2008

3058 — Development and Implementation of a Lean Redesign Program Using Implementation Science Principles within a VAMC

Woodward-Hagg HK (VA COE CIEBP Indianapolis), Workman-Germann JK (Purdue School of Engineering and Technology- Indianapolis), Woodbridge P (VA COE CIEBP Indianapolis), Justice C (VA COE CIEBP Indianapolis), Suskovich D (Purdue School of Engineering and Technology- Indianapolis)

Lean and systems engineering techniques have been used extensively and effectively to provide system redesign in manufacturing industries. However, these methodologies cannot be directly applied within healthcare systems to improve processes without extensive modification. This lack of “translation” has been cited as a primary limiting factor in spread of Lean and systems engineering tools and techniques within healthcare environments. We sought to describe an effective VAMC operations and HSR&D partnership in systems redesign.

Under the leadership of local VA managers, local VA staff and faculty have partnered with investigators from the VA HSR&D Center for Implementing Evidence Based Practice (CIEBP) to develop and implement a Lean Healthcare Program at the VA in Indianapolis, IN. As a part of this program, both 5-day Rapid Process Improvement Workshops (RPIWs) and 100-day Lean Healthcare programs have been developed and implemented. Brief pilot redesign project proposals are reviewed by VAMC and COE leadership and selected for funding. We specifically design projects to incorporate implementation science perspectives in design, measurement and implementation, including exploit Rogers’ characteristics of successful innovations. Multimethod measurement techniques, such a cultural assessment surveys and implementation tracking have been used to evaluate the sustainability and spread adoption of the program.

This combined systems redesign/implementation science approach has successfully been applied across 10 projects over the last 18 months. These project include optimization and redesign of operational aspects of Bar Code Medication (BCMA) Delivery Processes, DSS processes, elimination of paper based Medical Records, and schedule II narcotics delivery as well as for implementation of clinical practice bundles such as the MRSA bundle, post-operative glycemic control, and dysphagia screening assessments. Administrative infrastructure and tools such as a project tracker and dashboard have been created to support the program. The program is highly popular and achieving consistent improvements in processes and reducing waste.

Our partnership between hospital managers and HSR&D investigators has enabled development and implementation of a Lean Implementation Science Healthcare program to drive system redesign locally.

This administrative infrastructure, leadership support, and HSR&D input in design, measurement and sustainability, is a potential model for system redesign and spread.

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