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Lean Project Management in Healthcare

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A Patient-Physician Centered Methodology for a Modern Medical Practice

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Medical practice, healthcare, overall, is a high-stake project with multiple facets and determinants. Unlike many industries, such as Software as a service (SAAS) or medical device, quality and efficiency of the medical practice rely on a multitude of variables and determinants. The complexity of managing a medical Practice is increasing by the year. The larger organizations by trait are familiar to such complexity merely owing to the scope of responsibilities and size. However, in recent years after the advancement of the merit-based physician reimbursement model, smaller independent clinics are also facing comparable challenges.

Despite the overwhelming reluctance of mainstream physicians to adopt a more comprehensive practice management model (or project management methodology), they must realize their mistake.

The traditional medical clinic management is becoming outdated, while relatively speaking, smaller systems must follow similar guidelines set by the current healthcare policies as for their peers in large organizations.

In today’s healthcare arena, utilizing a project management methodology is more than just an option for independent physicians. But then again, choosing the right method carries the challenge of its own.

In my past writings, I tried to shine a light on the Agile project management methodology and its utility in medical practice. At the moment, I plan to discuss another pervasive project management scheme and shed light on some of its potential and pitfalls.

The Concept of Project and Project Management in Medical Practice

Today, practicing medicine is fierce, as the stakes are loftier, and like other institutions, such as hospitals that are familiar with practicing effective project management, they too will benefit from lower costs and improved outcomes.

In medical practice, patient well-being remains a distinctive element of the project, which makes it further complicated — and crucial. Investing in something that will assure increased revenue, decrease costs, and maintain compliance is worth the price and effort to make sure it’s done right; because the clinics and patients using it will invariably prosper.

Physicians that exercise powerful project management will benefit from lower costs and improved outcomes.

As trivial as it may sound, nevertheless defining the phrase “project” is one of the critical strides a medical practice requires to put up with- when initiating the project management practice within their walls. If not defined appropriately, a project can unwittingly become puzzling for the reason that everyone may speculate that everybody else typifies it identically where it is not necessarily true. Indeed, anything could be classified as a project. Yet the project is different from a task, program, or even a strategy. For simplicity, every physician practice should create a comprehensive, particular portrayal of what is interpreted as a project. However, In contrast to a program or objective, one necessary criterion of a project is that it must have a start and end date. Therefore, Accordingly, it compels the discipline of project management is about controlling and coordinating the start, the end, and everything that transpires in between. A typical project should again have an accountable owner and a fiscal appropriation. A fund implies tangible reserves allocated to this project.

The Four Stages of Project Management

It’s always convenient to assume that there is a necessity to “redesign the way our medical practice works or launch a project to enhance the billing process. But to be effective, plans must go from a one-sentence hypothesis to an entirely governed system.

There are many methodologies to establish optimal project management tools, however irrespective of the choice of scheme, all approaches implicate following four foundational stages:

Initiation- Defines the approved scope of the project, including projected costs, outcomes, and risks.

Planing- includes designing each step of the project, establishing deadlines, formulating a budget, and appointing responsibilities. The planning phase includes making decisions on how to measure the project’s progress as well as return on investment.

Execution and monitoring- This is the start of committing on the steps summarized in the planning phase. This stage is dedicated to tracking and measuring progress regularly to ensure the project is en route. During the execution phase, managers adjust the project plan, the schedule, and budget as required to minimize any negative ramifications. This phase is unique in medical practice management, as there are added layers of stakeholders who want to sign off on every aspect of the process.

Closure- Properly concluding a project is done in the closure stage. This is done by creating a document that summarizes outcomes, and deliverables, and lessons learned. Hence, evaluating particular circumstances with leadership and the project team will improve the project management process in the prospect.

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The typical Challenges particular to Medical Practice and Healthcare

In real life, every organization engages in some type of project management. The latter can refer to a highly systematic scheme and well-resourced or haphazard and bootstrapped.

Project management in medical practice has unicity of its own as it takes complicatedness and obstacles to an entirely different level. Some of the significant rationales that make healthcare much harder to manage versus other industries include:

High Stakes

There are harsher implications if projects go over budget or off schedule for the reason that patients’ well-being may be a stick. Any mistake or lack of process can potentially hurt patients.

Hefty Regulation

Currently, there’s a sharp requirement to protect sensitive patient information. To ensure that, facilities tend to add layers of consent, often necessitating sign-off by the practice administration, local, and national administrations. This leads to more compound ventures and more rigorous project management requirements. The healthcare industry confronts more legislation than other sectors, together with HIPPA’s patient confidentiality laws.

Surging Expenses

The proportion of insured anywhere in the world is the highest it’s ever been. The increased need for healthcare stirred with soaring costs has put more burden on the healthcare industry and medical practices to deliver discreet and high-quality services. Finding the balance between efficiency and quality places even more importance on the need for reasonable project management.

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Continual Shifting Industry

The healthcare and medical practice initiative is service-oriented and made up mainly by highly-skilled people who can’t effortlessly be restored by technology. While there are boosting demand for healthcare, there seems to be a shortage of healthcare experts, which is undesirably impacting yield. Effective project management can support widen that gap.

Increased Litigation Risk

One of the potencies of project management is that it helps mitigate risk, which is incredibly vital in litigation-prone medical practice. Establishing healthy, productive processes is the primary way project management reduces or eliminates risk by limiting mistakes made by the operating team.

Diverse Stakeholders

Many of the physician practice challenges, from massive regulation to elevated risk, translate to the engagement of many stakeholders in the system. Some projects in medical practice require approval from the board of directors, physicians, patients, and state and national governments, which can barely be dealt with well with appropriate project management.

Benefits Of Project Management in Medical Practice

When done carefully, the practice of project management is valuable to healthcare providers. It helps groups make improvements and operate more effectively in a variety of areas, including ProcessesPlanningBudgetingCommunication, and Stakeholder Relations.

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Conventional Project Management Methodologies in Healthcare

There is an assortment of project management procedures formulated for many businesses that can be pertained to in a healthcare environment, including waterfall, Agile, Lean, etc. The most common are Agile and Waterfall and Lean project management. Although many establishments see this as an either-or choice, there are ways to utilize these systems in a hybrid to realize the best of two or more methodologies.

The Lean Methodology

Besides being a tool, Lean is a business philosophy for advancement. This doctrine was derived from Toyota’s manufacturing experiences.

The lean focus is on curtailing waste in all business procedures, intending to reduce cost and lead-time as well as a boost in quality. Lean techniques are designed to result in slashing waste in projects, generating greater client satisfaction, and improved profit margin.

The Lean Objectives

The lean methodology objective is through Identifying the five basic principles of Lean, discover how Lean principles can be applied to given project management, and determine the various kinds of waste that exist in projects.

Organizations today must be able to do extra with a smaller amount. Several organizations are often looking for means to become more robust in the marketplace. Every new product idea must have a solid business case to support it. Otherwise, management would not authorize that project to proceed.

The Five Principles of Lean Process

Lean was invented for manufacturing exercises but, in recent times, has transformed the world of knowledge work and administration. It encourages the practice of unceasing perfection and is based on the fundamental idea of respect for people.

Womack and Jones distinguished the five principles of the Lean process, which are considered a recipe for improving workplace efficiency, this includes: 1) definition of value, 2) planning the value stream, 3) generating flow, 4) utilization of the pull system and 5) trailing perfection. The next section provides a detailed overview of each principle.

To better comprehend the tenet of specifying client value, it is vital to appreciate what value stands for.

Value is what the client or patient is inclined to pay for a service or product. To discover that, one must learn the actual or latent needs of the patient. Occasionally patients, physicians, and clients may not know what they want or are unable to articulate what they need. This is particularly widespread when it comes to novel products or technologies.

The identifying and mapping of the value stream, the goal is to use the patient or client’s value as a point of reference and then identify all the activities that contribute to these values. Functions that fail to add value to the end client are well-thought-out waste. The latter surplus can be broken into two groups; non-valued but necessary and non-value and redundant. The latter of the two is pure waste and should be eradicated, while the former should be reduced as much as conceivable.

After eliminating the wastes from the value stream, the following action is to ensure that the flow of the lingering steps run smoothly without pauses or pauses.

Some techniques for securing that value-adding activity flow smoothly include: breaking down phases, reconfiguring the production stages, leveling out the workload, creating cross-functional departments, and training employees to be multi-skilled and adaptive.

Inventory is measured as one of the biggest wastes in any production system. The objective of a pull-based strategy is to restrict inventories while working in process (WIP) items safeguarding that the essential materials and information are accessible for a smooth flow of work. In other words, a pull-based system permits for Just-in-time delivery and manufacturing where products are built at the time that they are desired and in just the quantities wanted. Pull-based systems are always created from the desires of the end clients. By following the value stream and working backward through the production system, you can ensure that the products produced will be able to fulfill the demands of clients.

Wastes are staved off through the accomplishment of the identifying value, mapping value stream, creating flow, and adopting a pull system. (the first four phases) However, the fifth step, pursuing perfection, is the most crucial among them all.

Pursuing perfection makes Lean thinking and continuous process growth a part of the organizational culture. Every employee should strive towards the end while providing products based on client desires. The company should be a learning institution and always find ways to get a little better each and every day.

The Lean Medical Practice

One of the significant characteristics of the Lean process that makes the methodology ideal for medical practice is because it starts with the patient and or physician and what he or she expects in terms of value. Only after, to think Lean continues with throwing out waste so that all work adds value and serves the patient’s needs, something which is the core objective of a typical value-based reimbursement. Hence, recognizing value-added and non-value-added steps in every process is the beginning of the drive toward lean processes.

For the lean methodology to be effective, medical practice leadership must first strive to create an organizational culture that is amenable to lean thinking. The pledge to lean must start at the very top of the organization, and all staff should be committed to helping to redesign methods to improve flow and reduce waste. Medical practices’ culture is the set of values and beliefs that cause people to behave in specific directions. That is the way when staff behave and continuously get the returns they anticipate. The set behaviors reinforce these values and beliefs, which in turn creates a self-reinforcing cycle, called “culture.”

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Leaders who are willing to change their organizational culture can’t do so by merely announcing their intention. Instead, their responsibility under the lean methodology would be to intervene and expect staff to behave differently, letting them experience a better set of upshots. As this process is repeated, a different assortment of values and beliefs will evolve, thus a new culture too.

In the process of rendering medical care for a patient, staff must rely on varied, sophisticated methods to accomplish their responsibilities and contribute value to the client or, in the case of medical practice, patient. Everyone at all times must relive at all times, waste of money, time, supplies, or goodwill decreases the value. Consequently, when applied rigorously and everywhere within the system, lean policies can have a positive impact on productivity, cost, quality, and timely rendition of services.

Examples of Lean thinking in Modern Healthcare

Virginia Mason Medical Center (VMMC) is an integrated healthcare system in Seattle, Washington. The company has efficiently implemented a lean culture based on six principles, including- placing patients as the driver for all their processes, The company has pushed an environment in which people feel safe and clear to engage in improvement that embraces the adoption of a “No-Layoff Policy” of its employees. The healthcare system also has Implemented a company-wide error alert system called “The Patient Safety Alert System.” Interestingly enough, VMMC supports the encouragement of innovation via the concept of “trystorming” which, according to it, starts and goes beyond what we typically have known as “brainstorming.” In contrast to the latter, trystorming involves swiftly seeking new ideas or principles.

The fifth and one of the most fundamental of all fundamentals of the lean methodology adapted by VMMC is the creation of a well-off economic system principally by eliminating waste.

Last but not least, the healthcare organization believes in accountable leadership.

ThedaCare, Inc., is a health delivery system based in Wisconsin. The company is nationally discerned for its quality achievements, which is also among the nation’s “most technology savvy, healthcare organizations.

ThedaCare leaders also have set driving and distinct objectives to ignite a culture transformation to Improve quality to “world-class” levels. The three missions of the ThedaCare Improvement System are; Improved staff moraleImproved quality, and Improved productivity. In the company’s project management structure, the new culture expects new attitudes, including the use of smaller, “right-sized” groups of staffers

or technologies in “cells” rather than extensive, cumbersome processes; sharp, sometimes directive leadership, enhancing more traditional team approaches; and less batching of work in favor of “right now” real-time effort.

The new culture of lean means that some roles shift. For instance, managers act as teachers, mentors, and facilitators rather than directors or regulators.

Is Lean Project Management Methodology Right for your Medical Practice?

Lean is designed and often used in healthcare and other industries to establish growth. The methodology strives to optimize operations and increase value for patients, physicians, and staff by eliminating wasteful spending. Nevertheless, deprived of a willing culture, the principles of lean will cease to function appropriately and thus fail.

In contrast to the lean scheme, methodologies like agile aim to deliver as quickly and frequently as possible while maintaining flexibility by allowing teams to rapidly utilize any feedback from clients when making changes to future work. That is why, more often than not, every individual medical practice will require its unique project management tool to deliver its expected outcome. The latter is achieved by selecting at least one, but most likely a hybrid of the two or more methodologies for a given project at a given time and place.

All in all,- Lean principles are rooted in widespread” respect” for the patient, and clients, with particular regard for fellow employees, appreciation for the current and future state of the institution. That is why Lean is lenient to implementation in hypothesis but frequently far more challenging to execute in practice, especially across larger establishments. Still, it is much easier to implement for small systems seeking potential growth in the future where Lean and medical practice culture grow in tandem.

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Adam Tabriz, MD
Dr. Adam Tabriz is an Executive level physician, writer, personalized healthcare system advocate, and entrepreneur with 15+ years of success performing surgery, treating patients, and creating innovative solutions for independent healthcare providers. He provides critically needed remote care access to underserved populations in the Healthcare Beyond Borders initiative. His mission is to create a highly effective business model that alleviates the economic and legislative burden of independent practitioners, empowers patients, and creates ease of access to medical services for everyone. He believes in Achieving performance excellence by leveraging medical expertise and modern-day technology.

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