COLUMBUS AIR FORCE BASE, Miss. -- Ask any medic at the Koritz Clinic about Continuous Process Improvement, and you will likely be steered toward their section’s Lean Daily Management board and given an in-depth explanation about an ongoing project. LDM is based on error reducing methods revolutionized by Toyota’s manufacturing operations in the 1980s. Lean process improvement principles have since moved from manufacturing industries to service industries, where the ideas now proliferate the healthcare system nationwide.
The Military Health System format for LDM originated at the 59th Medical Wing at Joint Base San Antonio-Lackland, Texas, as a simplified form of CPI designed for daily medical operations. Recently, the Air Force launched the new Trusted Care initiative with a focus on “zero patient harm.” As a result, LDM was quickly adopted and adapted as the method the Koritz Clinic utilizes to create a culture that embraces process improvement and error reduction, ultimately leading to better patient outcomes.
LDM thrives on structure and visual management, so daily briefs are conducted in front of LDM boards by the healthcare team members. This allows sections to flex according to daily operations concerns like manning or support issues. It also facilitates the identification of process concerns or potential CPI projects, and provides a venue to monitor the section’s ongoing CPI project.
Projects are designed to have a measurable and quantifiable goal, and data is tracked until a trend is observed. Root cause analysis is done, and countermeasures are created with projected timelines. When projects are worked to resolution, the project can be closed out. Section leaders complete a simplified “CPI 8-Step” which shows all phases of the project from data collection and root cause analysis, through countermeasure creation and implementation. Sustainability is key in LDM, so ensuring that new processes are captured in continuity binders, operating instructions, or group instructions is necessary.
Not every problem requires lengthy data collection and a root cause analysis, so sections are also able to complete and document “just-do-its” to track sustainable quick process changes.
Weekly leadership rounds solidify efforts by ensuring senior leaders and process improvement mentors are available to assist with additional resources or coaching when roadblocks occur. Since roll-out in 2015, the 14th Medical Group’s robust LDM program boasts a return on investment of 30 completed projects, numerous just-do-its. In 2016, the 14th MDG received kudos from the Joint Commission, a civilian healthcare organization conducting the 14th MDG’s accreditation survey.
The 14th Medical Group has also shared the best practices that it has gleaned from its program with the base Process Improvement Team. In return, the 14th MDG has leveraged the knowledge of the members trained at the Wing CPI Green Belt course to act as mentors in each section during rounding.
Ultimately, the LDM toolbox provides a conduit for effective change for those most vested in daily operations, and a means by which efficient and sustainable change can be created. In an environment where units are tasked to accomplish more with fewer resources, the waste reducing tactics of lean operations are essential to continued mission success.