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St. Luke's Internal Medicine and TEAMwork: 'I want it to be the best possible ...'

By Dr. David C. Pate, News and Community
February 22, 2013

TEAMwork works, and St. Luke’s Clinic Internal Medicine (SLIM) Parkcenter has proven just how powerful it can be.

TEAMwork is St. Luke’s application of lean principles. It’s our management operating system. TEAMwork stands for timely, effective, accountable, measureable work. And it’s making its way through St. Luke’s Health System as we gain on our Triple Aim of better health, better care, and lower costs.

Starting last summer, SLIM embarked on a top-to-bottom examination of how it conducted its work. They wanted to eliminate waste by tapping into the potential and knowledge of every member of the clinic team and build a culture of continuous improvement.

“I’ve just always been interested in efficiency and how we can make our operations run more smoothly,” said Site Manager Rachel Jaques, whose interest in TEAMwork served as a catalyst for SLIM’s effort. “It was also a great opportunity to get staff more engaged in our workflows.”

Jaques, Site Medical Director Dr. Leslie Stubbs, project executive sponsor and SLIM Medical Director Dr. Laura McGeorge, project executive sponsor Rhea Morrison, and staff members consulted with St. Luke’s Performance Excellence specialists to learn more about our TEAMwork operating system and how to apply it in the clinic setting.

They worked for more than four months to train, change their culture, make improvements based on their findings, and build new processes to better serve patients, their families, and clinic staff members. The TEAMwork model they’re using promotes transparency, engagement, visual management, and open communication. 

Alignment with strategic goals, data-driven decisions and tracking, and accountability around top priorities and action items and milestones are all facilitated by the use of a TEAMwork board and regular meetings to review progress.

“The communication board has been a new way to manage the clinic,” Jaques said. “It’s really data-driven, and makes sure how we operate every day supports the strategic goals.”

The results?

  • Before undertaking the work, 31 percent of employees strongly agreed that they had the opportunity to influence/effect change. Afterward, 71 percent felt that way.
  • Patient call-back time improved, from 56 percent being called back within two hours to an average of 90 percent being called back within that time period.
  • Standardized room set-up and rooming workflows resulted in a big decrease in unnecessary and/or expired inventory and increased efficiency for physicians and staff members.
The effort has paid off in multiple ways that benefit St. Luke’s patients, Dr. Stubbs said.

“Being able to take part in something that enhanced the efficiency of the clinic, primarily so we could spend more time in direct patient care and free up nurses to spend time with patients, and patients on the phone, all of that made a big difference,” she said.

 In the color-coded supply room, Denise Davis, patient business associate, left, and Site Manager Rachel Jaques can easily find what they need and what they need to order.

Clinic staff members identified dozens of opportunities for improvement and narrowed their list to 20 things that were less efficient than they wanted when it came to time, motion, resources, or other factors; out of that list of 20 priority areas, 14 have been completed, five are in various stages of completion, and one has not been started.

Performance Excellence team members joined clinic staff for weekly meetings and training sessions. Together, they trained around standardization and problem-solving, embarked in the “five S” visual management practices of sorting, straightening, shining, standardizing, and sustaining, and tackled auditing their use of the system.

They looked at their processes, including callback times and how nurses moved patients from the waiting room into exam rooms. They set a target of two hours for callback and have experienced impressive success in hitting that mark. Simply measuring callback time was informative, Dr. Stubbs observed, and improvement naturally followed.

When they found that nurses handled the rooming process in various different ways, they developed a standard that, while still leaving some latitude, now means new clinic employees can be trained in a set way and that all patients are prepared in the same ways, ways physicians anticipate, so that patient, physician, and staff time and effort aren’t wasted. To further enhance the patient experience and improve satisfaction for patients and staff members, signage was improved at the entryway and throughout the clinic.

After an item is completed, cards listing the work are moved to another board. "It's a visual way to manage daily tasks," Site Manager Rachel Jaques said.[/caption]

And they looked at their supplies and how supplies were managed. As it was, supplies were stored in different areas, with no standard set-up for exam rooms and other areas. SLIM developed a pilot room organized according to clinic needs, refined the room, and then reconstructed other clinic exam rooms following the pilot room blueprint. Now, all staff members and physicians know where to expect the same items in all exam rooms. At the same time, the effort allowed them to inventory, update, and redirect outdated and excess materials, sometimes hundreds of dollars’ worth of supplies.

“There wasn’t any pushback about getting a standard room,” Dr. Stubbs said. “Everyone was willing to participate and was pretty much in agreement about what we need. We don’t all do the same things, but we were still able to agree on a standard room set-up.”SLIM also partnered with our supply chain team to color-code the supply room as has been done in some of our hospital areas, with supplies organized by category. New processes also allow SLIM to order supplies by individual item, instead of in bulk. Reorganizing resulted in more than $1,800 in excess inventory being removed from the supply room.

SLIM’s success has helped St. Luke’s toward its 2013 goals of creating an exceptional patient experience and creating exceptional outcomes through TEAMwork. It has also improved staff morale and cohesiveness, according to the clinic’s internal survey.

When asked if “real teamwork and collaboration exists between most everyone in the clinic,” the percent that “strongly agree” improved from 38.5 percent to 57.1 percent, and the percent that “agree” improved from 23.1 percent to 42.9 percent; 38.5 percent responded “neutral” in the pre-work survey and no one responded “neutral” in the post-implementation results. And 13 of the 14 respondents, or 92.9 percent, indicated that “changes made in the clinic as part of the TEAMwork Building efforts have made things” “better” in the post-implementation assessment. One respondent indicated “at this point it is hard to tell.”

“I think the thing about the morale is not that it was bad, necessarily, but having people involved improved things,” Dr. Stubbs said. “People think, ‘This is my clinic, and our clinic, and I want it to be the best possible and function the most smoothly.’”

Our Performance Excellence staff is making it possible for TEAMwork to be applied in many different settings, to be practiced in different ways and to be applied narrowly or broadly. They’re active in rapid improvement projects that last a week and TEAMwork Building efforts, like the one SLIM engaged in, over a period of several months.

St. Luke’s has seen success with TEAMwork in pharmacy, supply chain, surgical services, orthopedic service line, and other settings, and projects are being conducted throughout the System.  

“It really was a way to get staff more engaged in our clinic and make everyone feel like they could share,” Jaques said. “You can’t go through the TEAMwork model without staff involvement.”

And SLIM isn’t done. Next up, according to Dr. Stubbs: procedure trays.

 “I think everyone agrees that those things take as long as they do because you’re going here and there, looking for what you need,” she said. “The idea (with TEAMwork) is that it’s continuous.”

About The Author

David C. Pate, M.D., J.D., is president and CEO of St. Luke's Health System, based in Boise, Idaho. Dr. Pate joined the System in 2009. He received his medical degree from Baylor College of Medicine in Houston and his law degree from the University of Houston Law Center.