VA Palo Alto Health Care System
Veterans Create Own Model of Care with 3P Project
VA Palo Alto Health Care System continues to use Lean principles to enhance efficiency as new construction expands access for Veterans. In a collaborative team effort, VAPAHCS aims to design and implement a new model of care using Lean 3P (Production Preparation Process), an event-driven process, for the new Major General William H. Gourley VA-DoD Outpatient Clinic that is under construction in Monterey.
The model will be a first in Veterans Affairs (VA), changing the way Veterans receive care by including them in development of processes used by staff, especially with the co-location of Department of Defense (DoD) medical staff in the same building.
The project includes more than 40 VA-DoD staff and leaders aiming to change the way our Veterans receive their care. Along with Veteran volunteers, the staff at the Monterey clinic conduct monthly design workshops using lean principles with a vision to help every Veteran be “Mission Ready for Life”.
During these workshops, Veterans share what they want in their healthcare experience, giving way to many great ideas. So far, the team has had three sessions to plan the work needed before the new clinic opens, for Patient Aligned Care Team (PACT) workflow on the day of visit, and for clinic information flow.
The one idea that came out of the workshop that resonated with both patients and staff was creating a plan for the estimated 60 patients that arrive each day without an appointment. Since most of these “walk-ins” are usually simple questions or pharmacy requests, the team is looking at how they can turn an unexpected situation into an opportunity to meet the Veteran’s needs in creative ways.
“We have urgent care appointments available for same-day appointments but they are usually filled, “said Dr. Mary Roberts, who was recently hired as the medical director for the Monterey clinic.
Using data from current patients and workload, they found “time” being the main problem. While this is no surprise as “time to care” is common among healthcare issues, there were several improvement ideas the team found to be crucial.
First, the team learned that everyone moves patients into rooms differently, which does not really help with time and efficiency of care. They created standard work for how they prepare a patient for an exam, which includes ownership of each piece of the process.
“We have already piloted co-locating staff in the current Monterey clinic, allowing us to work out any kinks. Clearly defining the roles of each staff also allows us to be more flexible and have the bandwidth to easily manage walk-in patients and meet their needs with the same quality of care as scheduled patients,” said Dr. Roberts.
The second workshop’s first improvement was on “out of cycle” work, which includes messaging, test results and medicine refills. They noticed how one message is copied to nine other people, aside from the team member doing the work. This means for the 1,000 messages created every month, an additional 9,000 copies have the potential to create confusion and duplication.
Standard work was created so only the patient’s care team receives the message. This change alone can save up to 117 hours of staff time per month.
Next, the workshop looked at the computerized record system to optimize the way the records are used. Small changes such as eliminating informational alerts that are not representative of clinic changes can reduce viewing time by 30 percent.
Another increasing piece to the new model of care that is an increasing need is mental health.
“In the new health care center, we will be co-locating mental health providers so that any Veteran with a mental health crisis can be immediately triaged and receive the proper care they need, without any delays,” said Dr. Roberts.
Part of this project also includes the physical design of the clinic. While Dr. Roberts is implementing the new improvements in care, Chris Izzo is working with his team in the Office of Facility Planning and Development (OFPD) to ensure the design of the new Monterey clinic complements the improved processes.
“We are leading the transition from the old clinic model to the new model, with everyone from the front-line staff to the executive level, as well as Veterans,” said Izzo, who serves as the Activation and Transition Coordinator for OFPD.
The 3P team along with OFPD created an off-site simulation center that allowed everyone involved to physically see how the new clinic would look and make recommendations. The simulation allowed them to make even the smallest changes, including how far staff will walk to answer the phone.
“Not only do they now understand the flow and procedures, but they are the creators. It will create a positive atmosphere for everyone, empowered and ready to work in the new space.”
He also serves as the VA-DoD Facility Coordinator for the sharing agreement document that will serve as the guide for the co-location of the two agencies in the clinic.
While the 3P team has made great improvements, there is a long way to go. Several more Lean events will take place leading up to the opening of the new health care center.
”This will always be a work in progress,” said Dr. Roberts.