Suntown Hospital is a critical access hospital located in a rural western State. The hospital serves the needs of a rural population with an outpatient clinic and a 45-bed inpatient facility, providing, acute, skilled nursing, and long-term care services. In 2000, a new chief executive officer (CEO) began his term at Suntown with the goal of creating a culture that supports quality improvement.
A rigorous case study of Suntown Hospital, which included 28 interviews with staff of all levels of the organization, occurred between February and November 2010. Data were collected during two site visits, through digital diaries recorded by Lean project participants and through phone interviews. Two projects, Urinary Tract Infection Prevention and Redesigning the Process for Electronic Prescribing, were selected for prospective study from this organization.
The hospital developed a 10-step process to implement Lean through "rapid-cycle events" (RCEs). These events bring together selected staff and stakeholders to examine each step of a targeted process. Staff spent approximately 3 days in training and in creating processes that are more efficient. At the end of the 3 days, staff developed an action plan to implement the proposed changes. Because of Lean, employee satisfaction appeared to increase. However, data collection remains a challenge at Suntown, so actual improvements in efficiency because of Lean are unknown.
Potential Lean adopters can benefit from some lessons learned from the experiences at Suntown.
- Leadership: Executives can set a positive tone for Lean by participating in Lean events with staff and taking on action items developed at the event. Additional support should be provided to teams when key leadership, such as process owners, become less involved or resign from the team.
- Education and training: Self-study modules and training integrated into a Lean event can be effective approaches to developing capacity to apply Lean methods in a small hospital.
- Resources: A workable data collection process is necessary for the Lean team to carry a project through to success. Find creative ways to collect data, measuring process change and project impact when resources are limited.
- Communication about Lean: Make plans to over-communicate process changes and the progress Lean teams make to staff that do not participate in a Lean event. People need to hear information in different ways and multiple times to understand and retain what has been said.
- Scope of Lean activities: Reviewing the medical evidence before beginning a clinical improvement project will help determine who should be part of a RCE team and will help focus the team on processes that will lead to improved care.
- Routinization: The best way to develop staff commitment to Lean is to have them participate in Lean events and to have early wins. Processes that were redesigned during Lean events or as a result of them, may still need further refining and even additional redesign over time. Furthermore, additional effort invested in staff training might be needed for widespread adoption to occur.
