Utilizing Lean Leadership Principles to Build an Academic Primary Care Practice of the Future
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Faculty Practice Operations & Ambulatory Services, University of California, San Francisco, San Francisco, CA, USA; 2Division of General Internal Medicine, University of California, San Francisco, San Francisco, CA, USA; 3Primary Care Services, University of California, San Francisco, San Francisco, CA, USA.
This Perspective presents a case study of multidimensional clinical transformation in an academic general internal medicine practice. In the face of increasing internal and external pressures, health systems and individual medical practices have pursued multiple strategies to improve quality, patient experience, and efficiency, while reducing staff and provider stress and burnout. We describe a Lean-informed approach that emphasizes the importance of organizational alignment in goals, evidence-based problem solving, and leadership behaviors to support a culture of continuous improvement. Our aim in this Perspective is to provide a real-world example of a feasible process for the planning, preparation, and execution of effective transformation, and to present lessons that may be useful to other academic health center practices seeking to develop innovative models to achieve the quadruple aim. KEY WORDS: academic transformation; Lean; continuous improvement; leadership behaviors; change management; burnout. J Gen Intern Med DOI: 10.1007/s11606-020-06246-7 © Society of General Internal Medicine 2020
INTRODUCTION
Academic health center practices face increasing pressures to improve the quality of care and patient and provider experience while reducing health care costs.1 These pressures are exacerbated by the high prevalence and negative impacts of provider burnout in academic primary care.2, 3 Addressing these challenges requires innovative approaches aimed at the transformation of primary care. In this Perspective, we describe a case study in one academic primary care practice that has launched a multi-year, Lean-informed, transformation. We describe our impetus for change, key guiding principles, and leadership engagement and change management strategies. Early learnings that may Sasha Morduchowicz and Jonathan S. Lee are co-first authors. Received August 28, 2019 Accepted September 14, 2020
inform other academic general internal medicine practices considering similar transformation efforts are also discussed.
Impetus for Change Amid concerns about faculty burnout, leaders at the Division of General Internal Medicine (DGIM) at the University of California, San Francisco (UCSF), surveyed physicianfaculty in 2015 to assess symptoms of burnout and work conditions using the Mini-Z Burnout Survey.2, 4 When compared with national survey results from other academic general internal medicine divisions, self-reported burnout rates at DGIM were among the highest.4 A taskforce was convened and found that burnout was a symptom of deeper root causes within the clinic, including a chaotic work environment, siloed workflows, poor team communication, and duplication and delays in responding to clinical messages, leading to
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