Using lean thinking to improve hypertension in a community health centre: a quality improvement report
Background Achieving better care at lower cost in the US healthcare safety net will require federally qualified health centres (FQHC) to implement new models of team-based population healthcare. Lean thinking may offer a way to reduce the financial risk of practice transformation while increasing th...
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| Format: | Article |
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BMJ Publishing Group
2019-01-01
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| Series: | BMJ Open Quality |
| Online Access: | https://bmjopenquality.bmj.com/content/8/1/e000373.full |
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| author | Patrick Lee Linhchi Pham Stephen Oakley Kimberly Eng Elena Freydin Tayla Rose Alyssa Ruiz Joyce Reen Deborah Suleyman Vanna Altman Kara Keating Bench Alice Lee Kiame Mahaniah |
| author_facet | Patrick Lee Linhchi Pham Stephen Oakley Kimberly Eng Elena Freydin Tayla Rose Alyssa Ruiz Joyce Reen Deborah Suleyman Vanna Altman Kara Keating Bench Alice Lee Kiame Mahaniah |
| author_sort | Patrick Lee |
| collection | DOAJ |
| description | Background Achieving better care at lower cost in the US healthcare safety net will require federally qualified health centres (FQHC) to implement new models of team-based population healthcare. Lean thinking may offer a way to reduce the financial risk of practice transformation while increasing the likelihood of sustained improvement.Objective To demonstrate system-level improvement in hypertension control in a large FQHC through the situational use of lean thinking and statistical process control.Setting Lynn Community Health Center, the third largest FQHC in Massachusetts, USA.Participants 4762 adult patients with a diagnosis of hypertension.Intervention First, we created an organisation-wide focus on hypertension. Second, we implemented a multicomponent hypertension care pathway. The lean tools of strategy deployment, standardised work, job instruction, Plan-Do-Study-Adjust, 5S and visual control were used to overcome specific obstacles in the implementation.Measurements The primary outcome was hypertension control, defined as last measured blood pressure <140/90. Statistical process control was used to establish baseline performance and assess special cause variation resulting from the two-step intervention.Results Hypertension control improved by 11.6% from a baseline of 66.8% to a 6 month average of 78.2%.Limitations Durability of system changes has not been demonstrated beyond the 14-month period of the intervention. The observed improvement may underestimate the effect size of the full hypertension care pathway, as two of the five steps have only been partially implemented.Conclusions Success factors included experienced improvement leaders, a focus on engaging front-line staff, the situational use of lean principles to make the work easier, better, faster and cheaper (in that order of emphasis), and the use of statistical process control to learn from variation. The challenge of transforming care delivery in the safety net warrants a closer look at the principles, relevance and potential impact of lean thinking in FQHCs. |
| format | Article |
| id | doaj-art-cdf0f61d77514cdfa966bb99ca428142 |
| institution | OA Journals |
| issn | 2399-6641 |
| language | English |
| publishDate | 2019-01-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open Quality |
| spelling | doaj-art-cdf0f61d77514cdfa966bb99ca4281422025-08-20T02:27:49ZengBMJ Publishing GroupBMJ Open Quality2399-66412019-01-018110.1136/bmjoq-2018-000373Using lean thinking to improve hypertension in a community health centre: a quality improvement reportPatrick Lee0Linhchi Pham1Stephen Oakley2Kimberly Eng3Elena Freydin4Tayla Rose5Alyssa Ruiz6Joyce Reen7Deborah Suleyman8Vanna Altman9Kara Keating Bench10Alice Lee11Kiame Mahaniah122 Harvard Medical School, Boston, Massachusetts, USA4 Tufts University School of Medicine, Boston, Massachusetts, USA3 Lynn Community Health Center, Lynn, Massachusetts, USA3 Lynn Community Health Center, Lynn, Massachusetts, USA3 Lynn Community Health Center, Lynn, Massachusetts, USA3 Lynn Community Health Center, Lynn, Massachusetts, USA3 Lynn Community Health Center, Lynn, Massachusetts, USA3 Lynn Community Health Center, Lynn, Massachusetts, USA3 Lynn Community Health Center, Lynn, Massachusetts, USA3 Lynn Community Health Center, Lynn, Massachusetts, USA3 Lynn Community Health Center, Lynn, Massachusetts, USANorth West paediatric registrar and clinical innovation and research fellow3 Lynn Community Health Center, Lynn, Massachusetts, USABackground Achieving better care at lower cost in the US healthcare safety net will require federally qualified health centres (FQHC) to implement new models of team-based population healthcare. Lean thinking may offer a way to reduce the financial risk of practice transformation while increasing the likelihood of sustained improvement.Objective To demonstrate system-level improvement in hypertension control in a large FQHC through the situational use of lean thinking and statistical process control.Setting Lynn Community Health Center, the third largest FQHC in Massachusetts, USA.Participants 4762 adult patients with a diagnosis of hypertension.Intervention First, we created an organisation-wide focus on hypertension. Second, we implemented a multicomponent hypertension care pathway. The lean tools of strategy deployment, standardised work, job instruction, Plan-Do-Study-Adjust, 5S and visual control were used to overcome specific obstacles in the implementation.Measurements The primary outcome was hypertension control, defined as last measured blood pressure <140/90. Statistical process control was used to establish baseline performance and assess special cause variation resulting from the two-step intervention.Results Hypertension control improved by 11.6% from a baseline of 66.8% to a 6 month average of 78.2%.Limitations Durability of system changes has not been demonstrated beyond the 14-month period of the intervention. The observed improvement may underestimate the effect size of the full hypertension care pathway, as two of the five steps have only been partially implemented.Conclusions Success factors included experienced improvement leaders, a focus on engaging front-line staff, the situational use of lean principles to make the work easier, better, faster and cheaper (in that order of emphasis), and the use of statistical process control to learn from variation. The challenge of transforming care delivery in the safety net warrants a closer look at the principles, relevance and potential impact of lean thinking in FQHCs.https://bmjopenquality.bmj.com/content/8/1/e000373.full |
| spellingShingle | Patrick Lee Linhchi Pham Stephen Oakley Kimberly Eng Elena Freydin Tayla Rose Alyssa Ruiz Joyce Reen Deborah Suleyman Vanna Altman Kara Keating Bench Alice Lee Kiame Mahaniah Using lean thinking to improve hypertension in a community health centre: a quality improvement report BMJ Open Quality |
| title | Using lean thinking to improve hypertension in a community health centre: a quality improvement report |
| title_full | Using lean thinking to improve hypertension in a community health centre: a quality improvement report |
| title_fullStr | Using lean thinking to improve hypertension in a community health centre: a quality improvement report |
| title_full_unstemmed | Using lean thinking to improve hypertension in a community health centre: a quality improvement report |
| title_short | Using lean thinking to improve hypertension in a community health centre: a quality improvement report |
| title_sort | using lean thinking to improve hypertension in a community health centre a quality improvement report |
| url | https://bmjopenquality.bmj.com/content/8/1/e000373.full |
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