1. DEVELOPING TEAMS OF
PROBLEM SOLVERS
Katrina Appell, Ph.D.
Lean Coach, Lean for Clinical Redesign CQI
University of Michigan Health System
Patricia Craig, BSN, RN
Continuous Improvement Consultant
Bronson Healthcare

2. Bronson Healthcare Group
• Regional not-for-profit
system, locally owned
and governed since 1900
• Three hospitals, several
ambulatory care centers,
multiple joint ventures,
and 82 Medical Practices
• Employs over 7,900 team
members

3. 3
What: Collaborative Process Initiative
staffed by University of Michigan
and funded by BCBSM.
Why: To Support the PCMH efforts of
Physician Organizations throughout
Michigan.
How: Leaders and clinic teams develop
lean capabilities while solving
problems through cycles of learning.
Lean for Clinical Redesign

4. Why did Bronson Participate in Lean
for Clinical Redesign?
“Wanted to access additional resources/tools to develop lean
thinking in the outpatient setting in a different way than how we
currently did the work (through kaizen events). We knew that the
kaizen (multi-day) event approach would not develop the necessary
problem solving skills in the office based setting fast enough nor
with enough depth and breadth.”
Elizabeth Warner, MD
Medical Director
Continuous Improvement
Support Team
Bronson Healthcare

5. Bronson Medical Group
Practices
4 Practices
included in each
Learning Cycle
12 Primary Care
Practices have
been involved in
Learning Cycles

6. Bronson Medical Group Practice
Results
73% to 85%
Mammogram Completion Rate – Bronson Internal Medicine Oshtemo
Implemented Chart Prep &
Mini Huddle Standard Work
50% to 93%
Accurate Demographics – Bronson Rambling Road Pediatrics
Standard Work for verifying
demographics at every point of
contact
Appointments Created Bronson Rambling Road Pediatrics
745 in 2014
Implemented Standard Agenda
Mini-Huddle

7. 7
Future /
Target
Facts
Current
Vision
Lean Learning grounded in
Continuous Improvement
And Respect
Challenge
Kaizen Mind
Go and See
Teamwork
Respect

8. 8
Lean for Clinical Redesign
Learning Cycle Model
Foundational Learning

9. 9
Set Problem Solving Direction
Ideal
State
Current
State
Problem
Definition

10. Understanding the Current Reality
Perceived Problem Actual Data Learning
Appointments scheduled
incorrectly caused appointments to
‘run over’
Of 870 appointments; 8 were not
scheduled per the Practice’s
guideline
Correctly scheduling
appointments is not
where improvement
effort should focus
Front desk team not available at
front desk
Multiple tasks pulled Front Desk
team away from desk. One large
reason was use of a copier
located upstairs to prepare new
patient packets.
Waste identified,
rerouted printer allowed
for files to be printed
directly to printer within
suite
Avoiding Jumping to Solutions
to Problems that Don’t Exist

11. 11
Engaging the Entire Clinic
Socialize:
• Value Stream Map
• Problem Definition
• PDSA Cycles
Daily at Huddles:
Share Problem Solving

12. 12
Create Habits and Routines
Supporting the Culture
Weekly:
• PDSA Session at Lean Daily Management Board
– Dedicated problem solving time
Monthly:
• Learning Collaborative
– Learning across
clinics

13. 13
Developing Leaders as Coaches:
PDSA Coaching Sessions
Plan, Study, and Adjust

14. Summary
• Learning provides information for the team’s
next steps
o collecting data to better understand the
situation
o conducting an experiment
• Teams are coached by leader; members
develop continuous problem solving
capabilities using lean concepts.
• Operationalizing problem solving shifts culture

15. Thank you!
bronsonhealth.com