While success deploying Lean in the hospital setting is well documented, Physician Practice Groups have been slower in their progress. Physician Practice executives often cite understaffed offices, the rapid pace of operations and concern that Lean is too complicated and time-consuming as the typical reasons for not getting on the Lean Healthcare bandwagon. However, in the face of relentless cost pressures, a group of Practice executives embraced an innovative approach to deploy Lean in an approachable and profitable way.

Mercy Health is a Catholic healthcare ministry serving Ohio and Kentucky. With more than 34,000 employees in eight regions, they are one of the largest healthcare systems in the country. At each one of their more than 450 points of care, Mercy Health delivers high-quality, compassionate care with one united purpose: to help our patients be well in mind, body and spirit. A key component of Mercy Health is the Mercy Health Physicians employed group practice, providing a comprehensive spectrum of primary and specialty medical services to meet patient needs.

Managing a large network of practices is a complex task, getting more difficult with the need to reduce costs and eliminate inefficiencies to cope with declining reimbursement rates and escalating supply and equipment costs. Courtney Seitz, RN, MSN, Chief Operating Officer of Mercy Health Physicians in the Cincinnati Region, is not the type of healthcare executive that waits for a crisis to happen before acting. Courtney feels the key to getting ahead on cost reduction challenges centers on empowering the often unsung heroes of the physician practice management world. Specifically, Courtney continues to focus on practical ways to build the skills of her practice administrators, the hubs for orchestrating delivery of physician-led services.

After a comprehensive search and a series of onsite briefings by a number of recommended consulting and training resources, Courtney and her executive team selected Leap Technologies as their preferred partner to assist in implementing the Lean program at Mercy Health Physicians in the Cincinnati Region. "Leap's approach was the only one that put a spotlight on empowering our practice administrators to lead the way," said Courtney. "What we saw from Leap was a relatively simple method for deploying Lean that our people would embrace as practical, fun and something they could do while meeting the daily demands of running our practices."

The core component of Leap's recommended approach was Rapid Action, a small-team, quick-impact approach with a 20-year track record of delivering measureable results at the frontlines of organizations. Widely used across industries, Rapid Action has been successfully deployed in a number of large healthcare systems, producing rapid cost savings and service improvement initiatives over 60-day timeframes. According to Courtney, "We were experiencing almost all of the issues that Leap shared as examples of Rapid Action's effectiveness in healthcare settings. We saw an opportunity to get an immediate return on our investment, while at the same time giving our practice administrators a terrific leadership development experience."

We were experiencing almost all of the issues that Leap shared as examples of Rapid Action's effectiveness in healthcare settings. We saw an opportunity to get an immediate return on our investment, while at the same time giving our Practice Administrators a terrific leadership development experience.

Top-Down, Bottom-Up Deployment

The landscape for deploying organization-wide improvement efforts is, unfortunately, littered with missed expectations, delays in realizing promised results, cost overruns and employee backlash. The problem is often over-promising, over-complicating and then under-supporting the initiative from the top, resulting in under-delivering of results from below. It's the no-win scenario that sours everyone's taste for change.

To avoid these common pitfalls, Courtney and her executive team crafted a plan with Leap to introduce Rapid Action on a controlled basis, governed by the organization's capacity for change and top leaders' availability and commitment to support improvement. The first step of the deployment was a one-day meeting for an expanded group of top leaders including directors and practice administrators responsible for multiple physician office practices. This Leadership Jumpstart event utilized Leap's method for helping executive teams prioritize their agenda to a critical few targets for improvement.

The Mercy Health leadership team targeted all four of their core service lines for deployment of Rapid Action teams, including Primary Care, Orthopaedics, Cardiology and Medical/Surgical Specialties. Using Leap's project planning tools, nine specific assignments were crafted to ensure alignment of key performance indicators to processes and procedures targeted for improvement. Team resources were selected and a 60-day implementation calendar created.

Following the Jumpstart Event, designated Rapid Action team leaders attended a simulation and practice-focused workshop to learn how to lead their Rapid Action teams. Modelling from the top down paid big dividends in signaling leadership's commitment to lead by example, while empowering participation at the frontlines.

Minimal Disruption / Maximum Value

Like most healthcare facilities, physician offices are busy places. Slow moving, time-draining improvement initiatives tend not to attract enthusiasm from frontline healthcare employees. Rapid Action operates on the principle of minimizing disruption to daily routines and maximizing the results and personal satisfaction of employees in every step of deployment.

Mercy Health's first wave of nine improvement teams were launched in physician practices across the network in a series of four-hour meetings that engaged more than 60 frontline employees. These Fast-Start Meetings provided the opportunity for employees to share their ideas and quickly organize, sort and select the best ideas for conversion into action plans. Team assignments included:

• How can we improve the process for managing physician utilization and productivity to increase patient access to primary care?
• How can we improve the cardiology appointment scheduling process in order to maximize patient throughput?
• How can we standardize the pharmaceuticals waste disposal process in order to continue to meet EPA guidelines and maintain compliance?

Unlike many other team improvement methods, Rapid Action makes the task of planning and leading team meetings as easy as possible for the team leader while also being efficient, productive, and fun for all team members. The key to this minimal hassle, maximum value approach is the Rapid Action Toolkit, a package of materials providing everything needed to facilitate team meetings including detailed meeting guides, posters, templates and supplies. Equipped with the Rapid Action Toolkit, team leaders can learn to run team meetings on "auto-pilot," free of worrying about what to do and when to do it to keep teams engaged and moving forward.

According to one practice administrator from Mercy Health's first wave of Rapid Action team leaders, "I was initially skeptical about following the meeting guides to the letter, but I realized after just one meeting how big a difference the Rapid Action Toolkit made in making my job easier and more enjoyable. It really took the pressure off the process and allowed me to focus on the team and our ideas."

I was initially skeptical about following the meeting guides to the letter, but I realized after just one meeting how big a difference the Rapid Action Toolkit made in making my job easier and more enjoyable. It really took the pressure off the process and allowed me to focus on the team and our ideas.

Results in Less than 60 days

The inaugural group of Mercy Health Physicians' Rapid Action teams all completed their work within 60 days, producing impressive hard and soft results. In total, the teams produced verified cost savings of $476,000 while implementing more than 50 specific action plans and another 30 "just do it" quick improvements.

The Rapid Action team focused on improving patient access to primary care appointments implemented a number of simple yet innovative actions, including:

• Ensuring all practices use the wait list feature in The Scheduling System to fill last minute cancellations
• Utilizing advanced practice providers to handle acute, same-day overflow visits
• Adding an after-hours clinic to primary care practices with consistent overloads
• Developing a communications process to have constructive conversations with primary physicians experiencing low access scores

In all, the efforts of the Action Access Squad (as the team named themselves) resulted in adding more than 56 primary care physician appointment opportunities per week to the schedule, producing an annualized revenue boost of more than $150,000.

For the Rapid Action team focused on standardizing the pharmaceuticals waste disposal process (appropriately named the Let's Get Wasted-Responsibly Team), the goal was to reduce risks. The team quickly got on top of the issues, brainstormed ideas and then implemented five key actions, including:

• Assessing the type of pharmaceutical waste produced in each practice and assigning classifications
• Reviewing pharmaceutical waste regulations and internal processes to ensure compliance
• Investigating industry best practices for RX waste to fill gaps or improve existing practices.
• Creating an internal audit tool for self-disclosure of risks and reporting on remediation actions.

In contrast to the Rapid Action team focused on primary care access, the actions of this team produced cost and injury avoidance benefits, demonstrating the versatility and range of the Rapid Action approach for addressing the myriad of issues confronting physician practice office managers.

According to another team leader involved in this first wave of Rapid Action teams, "Many of the ideas we implemented were common sense that any one of us might have been able to develop on our own. But the real magic of Rapid Action was the energy and support it provided for putting ideas into action and seeing them through to producing results."

Pay for Itself Leadership Development

The decision to deploy Rapid Action proved to be profitable not only in terms of organization performance, but also in meeting the executive team's expectation and desire to develop leadership talent. There was unanimous endorsement by the practice administrator team leaders to extend the deployment to the next level down with office practice managers leading the way. Feedback from these initial team leaders was that the Rapid Action experience improved their critical thinking, practical project management discipline and communication and team meeting facilitation skills.

The next group of Rapid Action Teams engaged 11 office practice managers as team leaders taking on new operating challenges including streamlining the patient registration process, implementing a standard interpreter service for all practices, improving the employee onboarding and offboarding processes and more. Results were consistent with the first deployment providing a mix of hard financial savings, cost avoidance and a positive leadership development and employee engagement experience for more than 40 employees.

Reflecting on her experience with Rapid Action, Courtney noted, "Success in the future of healthcare is going to depend almost entirely on frontline engagement and continuous quality improvement. The Rapid Action process provided the tools our leaders, particularly the less experienced ones, needed to drive improvements on dozens of initiatives in a short period of time. In that respect, Rapid Action has truly been a transformational event for our organization that will pay dividends for a long time to come."

The Rapid Action process provided the tools our leaders, particularly the less experienced ones, needed to drive improvements on dozens of initiatives in a short period of time. In that respect, Rapid Action has truly been a transformational event for our organization that will pay dividends for a long time to come.