Using Lean Performance Improvement for Patient-Centered Medical Home Transformation at an Academic Public Hospital.

Although Lean performance improvement (PI) has been used in health care for more than 15 years, little is known about how Lean has been used in Patient-Centered Medical Home (PCMH) transformation. We describe our experience implementing Lean in our safety-net, primary care teaching clinic. To advance high value care, a culture of systematic, sustainable PI methods needed to be integrated into primary care and taught to resident physicians. Clinic leadership were trained in Lean methods, protected time was dedicated to PI for a stable, interdisciplinary team, then visual management was introduced, and resident physicians were integrated into the clinic's PI initiatives. Self-assessment using the PCMH Assessment tool demonstrated improvement in core features of the PCMH model. Process outcomes also revealed successful, sustainable integration of Lean into our primary care clinic and resident training, and early findings show improvements in clinical quality outcomes. Patient survey outcomes demonstrate improvement in patient experience. Lean can be used successfully to promote PCMH transformation and create a culture of continuous PI in an academic, safety-net primary care setting.

尽管精益绩效改进（PI）在医疗保健领域已应用了15年以上，但对于精益如何应用于以患者为中心的医疗之家（PCMH）转型，人们知之甚少。我们描述了在我们的安全网初级保健教学诊所实施精益的经验。为了推进高价值医疗，需要将一种系统的、可持续的绩效改进方法文化融入初级保健，并传授给住院医师。诊所领导层接受了精益方法培训，为一个稳定的跨学科团队专门安排了用于绩效改进的保护时间，然后引入了可视化管理，并将住院医师纳入诊所的绩效改进举措中。使用以患者为中心的医疗之家评估工具进行的自我评估表明，以患者为中心的医疗之家模式的核心特征有所改善。流程结果还显示，精益成功且可持续地融入了我们的初级保健诊所和住院医师培训，早期结果显示临床质量结果有所改善。患者调查结果表明患者体验有所改善。精益可成功用于促进以患者为中心的医疗之家转型，并在学术性安全网初级保健环境中营造持续绩效改进的文化。