Improving Quality Through Lean Process Improvement: The Example of Clinical Decision Support

Abstract

The Institute of Medicine (IOM) defines quality in health care as being safe, timely, effective, efficient, patient-centered and equitable. Quality within Radiology, based on the IOM definition, can be broadly defined as safe, appropriate, effective and patient-centered. The key to actual quality improvement is to have a system in place that will both enable and sustain change. At Virginia Mason, we have adopted the Lean Manufacturing method to health care as our process improvement method for continuously improving the quality of care across the institution, including radiology. The major principles of the Lean process improvement methodology include the concepts of value, value streams, flow, pull and perfection. One of the basic tools of Lean is the concept of zero defects and mistake proofing. We have applied Lean throughout radiology to improve quality. One of the most important factors in the quality equation is appropriateness. In the rest of this chapter we will describe how we have used our Lean process improvement methods to ensure the appropriate use of imaging. There are two different imaging management methods that are currently employed, clinical decision support and preauthorization. These two methodologies are explored utilizing the Lean lens. Our implementation of clinical decision support to improve the appropriateness of imaging is an example of how the Lean process contributes to quality, safety and patient-centered radiology.