Health systems and physician practices continue to search for strategies to improve quality, patient experience and efficiency while reducing stress and burnout. One strategy, as provided by an academic general internal medicine practice in San Francisco, is informed by the lean approach. Lean emphasizes the importance of organizational alignment in goals, evidence-based problem solving and leadership behaviors to support a culture of continuous improvement.

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An article published in the Journal of General Internal Medicine, “Utilizing Lean Leadership Principles to Build an Academic Primary Care Practice of the Future,” provides a real-world example of a process for planning, preparing and executing effective transformation in a physician practice or health system.

“We decided that to really truly address physician burnout—which is what really brought the need for a transformation of our practice to my attention—we needed to look at everything that we did,” said Mitchell D. Feldman, MD, MPhil, chief of the Division of General Internal Medicine (DGIM) at the University of California, San Francisco (UCSF).

Learn about the four workflow changes UCSF made to help cut burnout by 45%.

“We're not the only ones dealing with burnout … but oftentimes, trying to address these systemic issues on a large scale is really difficult,” said Jonathan Lee, MD, a general internist and director of quality and clinical innovation for DGIM. The article lays “out some of the fundamental principles that are important in this type of large-scale transformational work.”

The lean approach is “not just about the tools and the improvement science that people get enamored with,” said Sasha (Morduchowicz) McKenzie, MPH, an administrative director for performance improvement in the ambulatory care department at UCSF. “It's also about the management system and the leadership principles that we really feel were essential to the early wins that we've seen so far.”

Here are three lessons the team at UCSF has learned that can help guide transformation at other health care organizations.

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“We actually established what we call true-north metrics, which are the vital few metrics of the whole organization—from the executive level all the way down to the front lines—that were important to focus on,” said McKenzie. “All of this transformation work was started within the context of that true-north vision that had already been set at the top.”

“Not to say that lean is the only way to achieve that organizational alignment, but really the principle of having a few key metrics that everyone knows are important to align with,” she said. “We did a lot of upfront work with gathering current-state information at DGIM to really show what are the key problems that everyone agrees are an issue and that we can learn from organizationally.”

“We can say, ‘There's burnout’ or ‘This is a problem,’ but when you present hard data that is factual, it can't be argued with,” said Dr. Lee. “It really lays out a much better case of what the problem is and how big the problem is.”

“One of the major things we looked at was the number of touches it was taking to resolve patient messages, which goes to the larger side of telecommunication,” he said. “It was taking an average of seven touches to resolve a message that’s being passed between several different people. It laid the case for why we needed to really rework this process and do better.”

However, with COVID-19, “we're trying to sort out an increase in volume in the inbox for physicians,” said Dr. Feldman. There has been “a bit of a regression from some of the progress we were able to make in terms of standard work, how messages are handled when they come in, how staff are supposed to handle them, and we're trying to figure out what's going on here.”

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“We engaged a lot of people, but to be continually communicating change, preparing for change and responding to issues that come up as we try to implement changes, we just found that we couldn't communicate often enough,” said Dr. Feldman, adding that “no matter how clearly we thought we were communicating, there was always a need to try to clarify the messaging even more.”

“It was so important that our faculty and staff feel like this was not happening to them, but that they were engaged in this process of change as well. Because, otherwise, it could worsen the very thing we were trying to address, which is this burnout issue that, in part, comes from a feeling that you don't have control over your work environment.”

The AMA’s STEPS Forward™ open-access modules offer innovative strategies that allow physicians and their staff to thrive in the new health care environment. These courses can help you prevent physician burnout, create the organizational foundation for joy in medicine and improve practice efficiency.

The CME modules, “Lean Health Care,” and “Listen-Sort-Empower,” are enduring material and designated by the AMA for a maximum of 0.5 AMA PRA Category 1 Credit

The module is part of the AMA Ed Hub, an online platform with top-quality CME and education that supports the professional development needs of physicians and other health professionals. With topics relevant to you, it also offers an easy, streamlined way to find, take, track and report educational activities.

Learn more about AMA CME accreditation

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