Jan 14 2013

Domino’s Farms Surgery Pre-Op Clinic adopts Michigan Quality System’s lean in daily work system

(From left) William Palazzolo, clinic director; Jennifer Tomford, clinic manager; and Linda Schaffier, medical assistant, discuss process improvement ideas during a leadership walk in front of the visual metric board.

Would you jump at the chance to improve employee satisfaction in your area if you could? Even if you weren’t sure you totally believed in the methods at hand?

Eighteen months ago, Bill Palazzolo, M.S.., P.A.-C, clinical director at Domino’s Farms Surgery Pre-Op Clinic, rolled out Michigan Quality System’s (MQS) lean in daily work system in his area and was pleasantly surprised.

“If you had told me years ago that lean worked, I wouldn’t have believed you,” he says. “But now I get it. I’m a believer.”

Knowing that patient satisfaction and employee satisfaction are linked, Palazzolo was looking to improve communication and satisfaction among his team, with the goal of improving the patient experience.

The clinic, which has been in existence for over 4 years, provides perioperative risk assessments and pre-operative risk optimization for scheduled surgical patients for the majority of surgical departments. Its patients are primarily adults—12,000 patients a year and growing—from ophthalmology to cancer to orthopaedic surgery, who have complex medical problems or potentially difficult airways.

Clinic staff sees 50 to 70 patients a day with appointments that last about an hour each.

The clinic has a full-time staff of 10 PAs, two registered nurses and five medical assistants. Rotating anesthesia staff as well as PAs and nurse practitioners from other surgical services also provide pre-operative care in the clinic space.

Since the clinic began its lean journey:

  • Employee engagement (a willingness to recommend your area to other employees) has seen a jump from 53.3 percent in March 2009 to 82.3 percent in March 2012.
  • Employee satisfaction, measured by the Lean Culture Survey, has seen an overall improvement of 20 percent. The two largest improvements—working in a fear-free environment and seeing waste and problems as opportunities—have risen 36 percent and 31 percent, respectively.
  • Time from patient check-in to check-out decreased 17 minutes—from 97 minutes to 80 minutes.
  • Employees submitted 170 everyday lean ideas —from assigning patients to employee workflow.
  • In their most recent survey, 90.9 percent of patients were pleased with the care they received, and 95.8 percent would schedule another appointment with the clinic.

Palazzolo attributes these successes to a number of lean-in-daily work activities, including 10-minute daily huddles in which the entire staff meets at the clinic’s metric board to discuss what they can do better or differently. Each employee takes the lead for a full week. “So we all own it,” he says.

“With our patients’ needs, what we do can be very complex. Lean helps us achieve highly coordinated patient-centered care.”

Associate Dean for Clinical Affairs and Professor of Internal Medicine Jack Billi, M.D., agrees. “The Pre-Op Clinic at Domino’s Farm’s is a ‘model line’ for the Michigan Quality System’s lean in daily work system,” Billi says.

“Bill and his staff integrate robust teamwork, visual management and structured problem-solving into how they do their work every day. Their employee engagement and patient satisfaction results prove out the lean maxim that ‘Good process produces good results.’”















2 Responses to “Domino’s Farms Surgery Pre-Op Clinic adopts Michigan Quality System’s lean in daily work system”

  1. Christine Poppy says:

    Congratulations Pre-op Clinic!

  2. Scherlyna Comer says:

    Bill and Jennifer,
    Congratulations to you and your team on a job well done!

Leave a Reply