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Insider North

Insider North Volume 1, Issue 1
Front page...

Lean’s 2P efforts wrap a warm blanket around new cancer center
Welcome to Insider North
Poudre Valley Hospital's "A" Building faces last days
Exec comp article prompted ethical discussion
Well-planned sting designed to improve patient information security
Medical group gets a makeover
Mobile app lets users track health, make tracks to local doctors
Learning from the best
Hospital video updates
Healthy U reaches out with useful health advice
Program helps employees Livewell

Lean’s 2P efforts wrap a warm blanket around new cancer center


Weeklong event centered on patient, provider flow

Slideshow: Click the play button to view a slideshow of the 2P event for cancer services.
A two-time breast cancer survivor, Vikki Wagner has high hopes for the impact Lean will have on the region's cancer care.

"What we're doing is huge," she said. "We are re-defining the cancer experience and making sure healing, hope and wellness are alongside great clinical treatment."

Wagner is the first patient to join a PVHS Lean team, a decision made to ensure a patient perspective was part of planning discussions for the regional cancer program serving northern Colorado.

The Lean process for the cancer network has big goals. The team is not only focused on services at and design of the new cancer center on the Harmony Campus in Fort Collins, but also on the broader scope of cancer services on a regional basis, including Greeley, Loveland and beyond.

Learning Lean

At a basic level, Lean thinking says a work process either adds value or it doesn't. The key is to analyze existing work processes, identify issues and create more efficient deliveries that improve value for customers.

Poudre Valley Cancer Network's customers are patients and families, referring providers and clinical specialists, including physicians, nurses and other team members who together provide cancer care.

With that in mind, representatives from physicians to nurses to clinic managers convened for week-long 2P work groups. 2P stands for process preparation, and it is a Lean method for designing optimal efficiency and flow in organizational processes.

For the first cancer 2P held in April, the cross-functional team mapped the current state of the cancer network's regional services. Mapping is the act of breaking a process into the sum of its parts. The process is similar, but more detailed, to those already performed in PDCA or Baldrige teams.

In mapping cancer services, care processes with no clear links, or flow, to other functions were flagged as issues: They represented gaps and fragmented care experienced by cancer network customers. The cancer value stream purpose is to remove the sense of fragmentation, or disconnected care processes, as much as possible.

Current-state mapping is challenging, considering upwards of 15 voices with highly passionate and different perspectives are at the table. But it's a critical part of getting all stakeholders engaged. It's a little bit like cleaning out a garage -- things get messier before they get more organized.

"Now we move to big-vision thinking," said Jose Bustillo, the PVHS Lean expert consultant (or sensei in Lean lingo). "Create the cancer program you would choose to offer if you knew no barriers. And the word 'can't' is not allowed."

Designing vision

After spending a day on current-state mapping, the team broke into smaller groups to imagine the best possible cancer program.

Knowing the challenges of the current state, the groups created seven scenarios for re-designing cancer care services. Each scenario was presented to the full 2P team for evaluation and ranking. Ultimately, the team chose a lead vision, or future state, by consensus vote. The week wrapped up with multiple scenarios to test the lead vision. Team members role played and walked through the proposed future state to note strengths and any remaining weaknesses, which could then be addressed through another round of improvements.

This same process was applied in early May with a second 2P focused on designing the cancer center. Team composition changed slightly: Wagner again joined the group to provide key patient insights; consultants from the architectural firm and contractor joined to ensure they were clear about project goals. An additional patient joined the scenario testing, widening the patient perspective that informed decisions.

One consultant commented on how learning the story behind the story is invaluable when it comes time for his team to construct the building. When it came time to envision seven buildings, the architects contributed real-time sketching to make ideas come alive.

Completion of the 2P value streams in April and May gave important shape to the future program of how patients will receive a new cancer diagnosis, multi-disciplinary treatment plans and, once treatment is completed, continuation of care that includes primary or palliative care, as needed.

For the cancer center, the architects are charged with turning the conceptual design discussion into a more concrete plan, with drawings scheduled for June.

At a May 11 report-out, the cancer value stream team shared exciting progress and vision for the Poudre Valley Cancer Network.

"Physicians are trained to have healthy skepticism," said Dr. Matt Sorensen, a Cancer Center of the Rockies medical oncologist. "I have to admit I came into this wondering what we could really achieve.

"But people invested so much energy and really collaborated. We listened to our patients and we created something attentive to their clinical needs and overall well-being."

As for the patient voice?

"I know I'm representing a lot of people, and it's an honor," Wagner said. "When we started this 2P process, it was agreed that when the patient speaks everyone would listen. And they really did."

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