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Lean Health Care Case Report: Harvard Vanguard Medical Associates

At Harvard Vanguard Medical Associates in Boston, MA, “measurement is the magic.” The appropriately named “Mission Control”—the location for the 7:30 a.m. weekly clinical operations meetings—is covered wall-to-wall with whiteboards filled with diagrams, metrics, workflow analyses, ongoing project status reports, and overall schedules. During these interdisciplinary team meetings, improvement specialists, physicians, and nurses tackle a list of open improvement issues—reviewing the status of each, and identifying barriers to improvement, responsible parties, and expected due dates. They review the status of recent “Rapid Improvement Events” (one- to two-week intensive Lean activities) as well as long-term projects.

One Rapid Improvement Event involved optimizing the automated phone triage system. Formerly, the only option was “Press 1 for medical advice.” The team reviewed data and quickly learned that most calls were for refills, followed by appointments and then medical advice. As a result of this review, the team decided to reorder the automated options accordingly; now “option 1” connects the patient to someone who can assist with refills, “option 2” is for appointments, and so on. This enables Harvard Vanguard to more quickly get the right calls to the right people to better and more efficiently meet their patients' needs when they call.

The pursuit of standard work is the cornerstone of Harvard Vanguard's Lean philosophy. For every work process, there is a clearly defined series of steps completed by those who do that specific work. For example, patient form completion starts with medical secretaries when the patient arrives in the clinic, moves to licensed practical nurses when the patient is taken to the exam room for their visit, and goes ultimately to the physician, who completes any final work and signs off. To help all team members standardize their processes, members periodically observe each other in an informal peer-to-peer audit. If the worker gets the process right, the auditor shows a green card. If the standard work is completed incorrectly, an orange card is shown. The purpose of the audit is not to scold workers but to identify how consistently a process is completed and whether a member of the team needs assistance or additional training.

Harvard Vanguard's commitment to Lean process improvement has benefitted the whole team. They have achieved greater efficiencies by eliminating waste, and they are able to provide better, safer care to patients.

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