Presentation Authors: Anas Tresh*, San Francisco , CA, Andrew Cohen, Benjamin Breyer, San Francisco, CA
Introduction: Lean is a continuous process improvement strategy designed to increase efficiency, safety and competitiveness. Zuckerberg San Francisco General (ZSFG) is a community safety-net and trauma hospital that serves as a major teaching site for the University of California San Francisco. We developed a urology service specific Lean Daily Management System driven by our resident and fellow physicians to improve efficiency, safety and the overall patient experience. Using a formal problem solving tool, residents are empowered to propose target statements, identify barriers, countermeasures and analyze their positive impact on patient care. Our objective is to assess the effectiveness of this approach.
Methods: We examined our Lean activities from July 2016 to October 2018. Our weekly huddle serves to surface logistic, safety or equipment concerns, generate and mark progress on improvement ideas amongst stakeholders. On operating room (OR) days, we conduct a 5 minute huddle prior to case start to review cases, anesthetic approach, positioning and equipment needs.
Results: Over a 2 year period 34 projects were developed by the resident team to improve work flow and patient experience. Projects most often impacted the outpatient setting (65%), followed by inpatient (21%) and the overall service (14%). Most projects related to the quality (n=13), workforce development (n=7), care experience (n=5), equity (n=5), safety (n=2), and financial stewardship(n=2). UroLean was used to improve next available outpatient clinic appointment wait from 168 to 21 days. BCG treatment times reduced from 180 to 105 minutes by identifying clinic flow changes such as ordering BCG the evening before, sending reminders to patients and prompt insertion of catheter. The urology on-time OR average start-time was better than the overall OR mean (71% v 61%, respectively) (Fig 1). Common barriers to on-time start identified via this process included: patient related factors (25.93%), anesthesia (17.59%), housekeeping (17.54%) and surgeons (12.9%).
Conclusions: Residents were successful in applying LEAN in a safety-net hospital. Our department improved communication within our team and across service lines. Lean provides structure and can be an effective tool to improve resident engagement in quality and safety endeavors.