Posted by: knightbird | October 4, 2011

Using Lean Tools as a 3P for Integration of Primary Care and Behavioral Health Services

Chugachmiut’s Restoration to Health Strategy was designed to treat tribal members holistically. As research has demonstrated, negative behaviors such as smoking, overeating, substance abuse and others lead to serious health consequences later in life. Such behaviors also cause considerable complications for teenagers and adults. Integrating healthcare and behavioral health is a natural precursor to addressing issues holistically.

We have a 3 day event underway at our regional clinic with staff from both divisions participating with what is basically a 3P event. In lean terms, 3P refers to “Production, Preparation, Process.” We will be talking about the patient and client journey, and how we can facilitate that journey with the least amount of waste and lead time. Our 3P for integrating services is currently on 2 parallel tracks. The first is the design process I have described in earlier blogs for a new clinic. The current event in Seward is to plan the integration of services.

With 2 value streams being integrated, the respective roles for providers need to be well thought out. Documents, electronic health records, handoffs, joint discussions and assessment tools are all on the table for discussion. Even more complex is the thinking about the role each type of provider will play.

My Executive Team and a couple of board members had an opportunity to visit Cherokee Health Systems in Knoxville, Tennessee. Their processes have led to great provider interaction where they each view the other as a valuable partner in producing results for their “Patient Client.” We have also had the benefit of documents used by Kaiser Permanente San Diego, where they do a biopsychosocial assessment for new clients.

Chugachmiut has reasonable, but not an excess, of resources. Many of the resources we do have are a benefit from our Lean Culture. Most of our efforts in the first 5 years of our Lean Implementation were to change the culture and repair broken processes. We then shifted into a phase of small but continuous improvement. This next phase involves the 3P method for radically changed services and Lean Design in the use of our facilities. We must continue to learn in order to meet the challenges we encounter in serving our tribal members.

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