OR Manager - November 2018 - 25

Performance improvement
Value stream maturity: Common characteristics
Developing Mature
Early
A sponsorship committee
is established
Provider lead is
committed through at
least first project
Value-derived outcome
scorecard is actively used
Patient-centered
outcomes are at least in
development
2 to 3 years of sustained,
improved results
Scorecard features
patient-centered
outcomes, and results
are transparent within the
organization (ready for
external transparency)
Hospital resources
assigned
Population is defined
Two projects are
complete
Value stream owners
think beyond short-term
tactics
Value stream is defined
Source: Robert Pendleton, MD. Used with permission.
projects from the current 6-month time
frame to 16 weeks, a benchmark that
comes from Case Western University in
Cleveland, Ohio. To do that, it's sometimes
necessary to replace one physician
leader with another who is more
available.
" It's a challenge to balance the value
stream work with clinical duties, " he
acknowledges. " Our leaders have been
remarkably resilient in readjusting staffing
to get the involvement needed from
our OR teams, nursing, pharmacy, and
other units. They view this as missioncritical
work for us to continue to evolve
as a health system. "
Each value stream program progresses
through three levels of maturity
before they are considered fully developed
(sidebar above). Each program
has a value-driven outcome scorecard
that reflects overall cost of care and
the individual component cost of care
(eg, pharmacy, supply, labor on different
units) and outcomes of the patient's
value stream, along with team-defined
process measures that are put into a
" perfect care index, " Dr Pendleton says.
" That scorecard, which is an aggregate
www.ormanager.com
of a particular patient population, is
disseminated monthly to the team and
periodically to the entire organization.
Although it's disseminated in a static
form, our platform allows the team
members to drill down to an individual
patient level for more information, " he
explains.
" Each month, we highlight the current
results of an active project as well
as the changes in outcomes and costs
across all of the programs, " he says.
" We also have an online 'community of
practice,' which is a way to share improvement
work across the entire organization. "
Information about the project
and team members is posted on Accelerate,
an open-source platform that is
accessible both internally and externally
and has around 40,000 visitors each
month.
Patient participation
A chief outcome of doing value stream
work is achieving a better understanding
of the patient's journey, according to
Dr Pendleton. For example, in the case
of joint replacement patients, the team
has taken steps to better communicate
Continuous improvement
pervades the thinking of
value stream owners
Reins of program
leadership and
sponsorship have been
handed off
Next 1 to 3 improvement
opportunities are planned
and prepare patients for postoperative
care. " That empowers them to manage
and thrive at home versus going to a
rehab setting, " he notes.
When it comes to postsurgical care
after colectomy, the team learned that
patients were the best teachers. " Really
listening to the patient completely
revamped how we were preparing them
for fluid management post discharge, "
he says. " A patient who has learned to
manage a new ostomy can communicate
what to expect at home in far more
practical terms than the clinical team
could. " This realization led to producing
education videos by patients for
patients.
From silos to solidarity
Value stream redesign has united
teams that were once working in silos.
" Aligning everyone with the patient's
value stream leads to better teamwork
quantified by the results of the project
and an informal esprit de corps, " Dr
Pendleton says.
" We're looking for fundamental
changes in how we're caring for patients, "
he adds. " If we look hard
enough, there's always significant opportunity
to redesign how we deliver
care. " ✥
-Elizabeth Wood
References
Holden R J. LEAN thinking in
emergency departments: A
critical review. Ann Emerg Med.
2011;57:265-278.
Gellad Z F, Day T E. What is value
stream mapping, and how can it
help my practice? Am J Gastroenterol.
2016;111(4), 447-448.
Teich S T. LEAN management-The
journey from Toyota to healthcare.
Rambam Maimonides Med J.
Published online April 30, 2013.
https://www.ncbi.nlm.nih.gov/
pmc/articles/PMC3678835/.
Toussaint J S, Berry L L. The promise
of LEAN in health care. Mayo Clin
Proc. 2013;88(1):74-82.
OR Manager | November 2018 25
https://www.ncbi.nlm.nih.gov/ http://www.ormanager.com
OR Manager - November 2018

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