The process worked in part because BAC selected staff and providers who would not have problems leaving their titles at the door and focusing on flow, Millermaier says. "The physicians were willing to hear, 'Gee, Doc, when you do that with the chart, I can't find it. When I can't find it, I can't meet the need of the patient.' The medical records clerks were willing to hear that they had to reorganize their medical records. The insights that they got on how to fix flow problems were enough that they could clean up the medical records process. They figured it out on their own. Those were line associates, not the managers."
Tom Leyden, manager of clinical program development at BCBS Michigan, said the Lean program began in June 2008 and now includes approximately 8,000 physicians from about 100 large physician groups in the Lean Professional Collaborative Quality Initiative.
Not every physician group is ready for Lean, Leyden says.
"Once they express their interest, there is a readiness assessment where the coordinating center out of U-M Health System meets extensively with the physician group to determine if they're ready to embrace Lean," he says. For some organizations, it might be a three- to six-month process to determine whether there is strong organizational support for it and to start thinking about what they want to address.
Leyden says BCBS Michigan will fund any Lean program in the ambulatory setting that will improve quality of care and advance the practice "along the path to a fully functioning patient-centered medical home."
BCBS Michigan fully funds three value stream mappings for physicians' groups, which usually take more than 18 months to complete. Consultants' fees are paid by the insurer, which also provides the physicians' groups with about $15,000 to provide compensation for any temporary disruptions to practice work flow.
"The expectation is that each organization will have at least one person who will become the internal Lean coach. It's a 'see one, colead one, do one' approach," Leyden says.