What are your thoughts on this case study in relation to Poka-Yoke" - mistake-proofing and jidoka ?

Each day mistakes and defects occur in health care, and they can harm patients while eroding patient and staff satisfaction. Care teams spend valuable time fixing mistakes that could otherwise be spent caring for patients. Mistakes and defects also add to the overall cost of care. Examples in primary care include rooming mistakes, scheduling patients for the wrong provider, medication errors and neglected tests and vaccines. Virginia Mason Medical Center has been on a journey to mistake proof primary care since 2002. One guiding principle has been to equip clinicians with vital patient information they need to care for their patients. This lean concept is defined as jidoka or having the instructions and knowledge necessary to do ones job right the first time, at the point of care. The following improvements were designed with input from doctors, nurses, medical assistants and customer-service representatives from Virginia Masons Primary Care Department

Encouraging preventive screenings First, Primary Care designed new standard work in appointment scheduling to support preventive care. Now when a patient requests an appointment, a patient services representative checks the computer to identify any preventive tests the patient is due for and offers to schedule them right at the point of service. Virginia Mason also added a Health Maintenance Module to its electronic medical records to make patients preventive care needs more visible. While rooming the patient, the medical assistant uses the module to flag tests the patient is due for in the medical record. The flag becomes the first note a physician views during the visit, which must be modified before the physician can proceed any further with the visit.

Leveling the skills of the team Primary Care also ensured that each health care team member was doing the right work for their skill level, also known as level loading or heijunka. Several tasks that physicians previously handled were reassigned to others. For example, now medical assistants practice to the top of their certification; their responsibilities include going through the problem list with the patient, performing more set-up and prescreening, reviewing medication lists, verifying allergies, reviewing test results and administering vaccines.

Planned care Primary Care also experimented with delivering more intense care and coordination for the patients who are sickest in a primary care setting. They participated in a pilot with The Boeing Company and Regence BlueShield to reduce Boeings healthcare costs for its employees with the most expensive health conditions by 15 percentall while improving their health status. Part of the intervention included planned care for patients with chronic or complex conditions by nurse case managers who provided phone support and coaching as well as visits with nurse practitioners and physician assistants. The pilot lowered Boeings healthcare costs by 33 percent and reduced hospital admissions, despite the additional expense for nurse coaching. Quality also improved: More patients with diabetes were placed on statin drugs and more diabetes patients reported healthier cholesterol levels (from 40 percent in 2000 to 68 percent in 2009). Patient and staff satisfaction also improved between 2002 and 2005, with staff reporting that they knew what was expected of them

Conclusion By implementing standard work that encourages preventive care, Virginia Masons primary care patients are receiving care that is more proactive and systematic. Clinicians are better equipped to care for their patients because they have the information they need right at their fingertips. By leveling the skills across more members of the health care team, no single member of the health care team is overwhelmed and responsibilities are clearly defined. Planned care is also improving quality for patients with chronic and complex medical conditions, reducing hospital admissions and saving money.