By Leonid Gorelik, DNP (c), MSN, RN, NEA-BC
As part of my Doctoral work at Yale University, I was allowed the opportunity to conduct a change project at my current work setting. The focus of the project is utilizing the Lean process improvement framework in identifying barriers that impede patient flow in the Adult Ambulatory Surgery Unit (ASU) at the New York Eye and Ear Infirmary of Mount Sinai. I first learned of the Lean framework from my readings on quality improvement. The more I read about Lean, the more I began to understand what the methodology entailed. Being actively involved in the Lean process, however, is an entirely different experience than reading about it.
I learned of Dr. Lucy Xenophon, MD, MPH, CMQ, Chief Transformation Officer at Mount Sinai St. Luke’s and her work with Lean after discussing my change project with Dr. Sonja Tennaro, Ed.D, RN, NEA-BC, FACHE, Senior VP of Clinical Operations/CNO at NYEE. During our initial conversation, I explained to Dr. Lucy Xenophon the reason for my contacting her. After speaking with Dr. Xenophon, she invited me to participate in the first Kaizen event at MSSL. The word “Kaizen,” is frequently associated with the Lean process, and is defined as “continuous incremental improvement.” The Kaizen event at Mount Sinai St. Luke’s consisted of a week-long workshop comprised of a team of six members, both leaders and front line staff, who intensely study work focusing on improving processes identified as broken or defective.
On Day 1 of the workshop, I had the opportunity to get to know each member of the work group. The work group consisted of a unit clerk, registered nurse, nursing manager, chief resident and an attending physician. From the beginning, the group’s energy level was high and the enthusiasm of each member was evident. As a group, we set our expectations for the workshop early on. One expectation that made a significant impact on me was the notion that titles would not be used. We were all on the same level; no hierarchy. Each member’s input was just as valuable as the others. This motivated each member to actively participate in the discussions. We received a brief introduction to Lean and discussed some of the most common strategies employed as part of the methodology. We discussed the scope of our specific Kaizen event and reviewed the current situation, which was targeted for improvement. We reviewed the baseline data collected on the current situation and developed target metrics to gauge the success of the group’s efforts.
Days 2-4 were focused on transforming our strategies for improvement into action. As part of the workshop we would go to the Gemba (a word commonly used in Lean to describe the place where the work is done) to further study the current situation and engage the front-line staff, not part of the work group. This was the most interesting part of the entire experience. The group was able to design process improvement experiments incorporating feedback retrieved from the Genba, mobilize the feedback into an action plan, implement the action plan and measure its effectiveness. This process helped reinforce the notion that a critical success factor of Lean application is the make-up of the Lean team who are front-line staff who do the work daily and who are familiar with every step in the process.
Our work was facilitated by David McCoy the project manager who was equipped with no more than post-it notes, white boards, colored markers, flip charts and a mission of getting us closer to the goal we set out to reach from the very beginning. Together, we intensely studied the problem using Lean strategies including the Fishbone Diagram, Value stream mapping, A3 report and time-study observations. As we developed our solutions, we kept the following saying (offered by Dr. Lucy Xenophon) in our minds, “creativity before capital”. At the end of each day, the team leader would report out the day’s work to the executive steering committee. Feedback from the executive committee would then be incorporated into the next day’s work.
On the last day, our group, which we formerly named “The Starters,” completed a PowerPoint presentation depicting our five-day Kaizen journey and the fruits of our labor. We were able to prove to ourselves, as well as others, that the Lean process works, which was as evidenced by the attainment of our goal. The presentation was well received by all who attended including Arthur A. Gianelli, MBA, MPH, President of Mount Sinai St. Luke’s.
This experience has significantly improved my understanding of the Lean process and confirmed for me the power and impact a group of front-line staff can have on quality improvement, when facilitated by an engaged senior leadership team and expert facilitators. I have also learned from this experience that quality improvement does not have to translate into a long, drawn-out routine of meetings and lengthy approval processes. This was an invaluable experience and I look forward to implementing the Lean methodology at NYEE.
Leonid Gorelik is the Nursing Care Coordinator for the Ambulatory Surgery Unit and Pre-Admission Testing Center at NYEE. In addition to pursuing his Doctorate in Nursing Practice (DNP) at Yale University School of Nursing, he currently holds a Master of Science degree in Nursing Administration from New York University. He is a board certified Nurse Executive accredited by the American Nursing Credentialing Center. He serves as the co-chair of the Nursing Quality Council and has conducted numerous quality improvement/performance improvement projects throughout his four year experience working at NYEE.