Lean principles and processes have become important tools for transforming health care delivery, transparency and cost. Yet, while more and more success stories are emerging on the system side, there’s an opportunity for "Lean" in managing population health.
Population health — whether it’s caring for a specific patient population by condition or addressing social determinants of health at a societal level — is a large-scale effort to affect the health of an entire group of people. So how, specifically, can the principles of Lean help accomplish this effort?
1. By bringing a focus to patient populations. Many existing experiments in Lean already focus on a particular patient population by outlining the full value stream of care and by measuring outcomes. The next step is to go beyond a single facility or system — to apply the same processes and learnings to the population of a state or region.
2. By freeing people to ask why. Repeatedly asking this simple question helps Lean leaders identify the cause and begin the plan-do-study-act cycle of testing improvements. Learning to ask “why?” often is a key factor in unleashing critical thinking skills among front-line staff.
For population health, it is perhaps even more critical to ask these questions:
• Why do chronic populations struggle with managing care?
• Why are we not connecting more services to get them to the care they need?
• Why are we letting existing barriers stand in our way?
Imagine the flood of innovation that might sweep through population health organizations if leaders and front-line staff felt empowered to ask these types of questions and then search for Lean-based solutions.
3. By connecting hospitals and systems to communities. Lean processes can connect clinics to communities and expand care beyond the doors of a facility. Just as standard work from one model cell unit can spread to the entire system, the learning and process from one system can spread to the entire community. It sets a shared vision. An integrated effort moves us one step closer to making sure all parties involved in a patient’s care — community clinics, social services, etc. — are working from similar standards. It also helps align incentives.
4. By empowering the voice of the customers and putting them at the heart of all we do. This is a key principle of Lean in any format, and it takes on special significance when looking at care through a population health lens. The attention to the voice of the customer engages patients — particularly those who may be facing chronic or challenging conditions — in new ways. By involving patients and educating them to take more ownership of their own health, Lean is in a unique position to influence population health.
5. By connecting data and metrics to identify better-targeted solutions. One of the big impacts of Lean has been an increased focus on and database of quality metrics. This type of accessible information on quality is vital for population health efforts to improve care and identify where further attention is needed. It could help put resources where they can best make a difference and shed light on the key emerging issues in population health.
6. By allowing states and regions to more fully put into action, adapt and learn from successes of local health systems. As more and more health leaders and systems have implemented Lean and realized success, leaders on the population health side have become energized to do the same. Lean empowers these leaders with data, standard work and new perspectives on management. It also lets them build on the individual successes of local health systems and expand those ideas to other facilities, or for other conditions, across the state or region. The good news is that this already is happening through many states’ health improvement plans, which help spread Lean principles and engage community clinics and other population health hubs.
7. By moving community clinics and public health toward regular reporting of quality measures. In Wisconsin, for example, Sixteenth Street Community Health Centers has begun tracking key indicators as part of the Wisconsin Collaborative for Healthcare Quality. Participation in such quality or data reporting collaboratives gives population health organizations the chance to engage with like-minded providers to compare quality results and to access resources and new ideas.
At the same time, including population health voices at the table helps traditional providers broaden their thinking about social determinants of health.
It’s important to note that many community clinics and population health leaders already have started on their Lean journeys and are seeing the benefits.
I remain optimistic that more will follow suit and that health leaders, too, will expand their focus beyond lean within their facilities or systems to invest in transformation at a communitywide level.
John Toussaint, M.D., is the CEO of the ThedaCare Center for Healthcare Value in Appleton, Wis. He is the author of Management on the Mend: The Healthcare Executive Guide to System Transformation.