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May 17, 2021 The Big Picture

‘Lean’ principles help Hartford HealthCare adapt to ever-evolving pandemic

PHOTO | CONTRIBUTED Staff at Hartford HealthCare applied Lean and other business principles to optimize sites like this field hospital, built at Central Connecticut State University in New Britain in April 2020.

Hartford HealthCare (HHC) executives chose a scenario for their Sept. 2019 systemwide emergency drill that seemed unlikely at the time: A pandemic caused by a mutated influenza virus.

“I had always thought that a systemwide emergency for us would have been a hurricane or an extensive blizzard,” said Patrick Turek, director of emergency management for the statewide hospital network. The COVID-19 pandemic hammered Connecticut only four months later.

Patrick Turek

“Based on that exercise, we had to quickly accept the reality of what was happening and implement a highly organized structure to respond to this emergency,” Turek said.

Thanks in part to that 2019 drill, HHC was able to respond decisively and preserve basic functions even as other providers buckled under the strain.

What helped HHC make quick and decisive actions in response to the evolving COVID-19 crisis over the past year was training in the principles of Lean, a system born out of manufacturing that has made major inroads into business management practices at enterprises large and small. Some basic tenets of Lean include continuous improvement and waste reduction — whether of money, raw materials or employees’ time.

HHC’s custom blend of Lean, emergency management and healthcare-specific project management in responding to the COVID-19 crisis has drawn national attention — and an invitation to speak in March at a Project Management Institute event attended virtually by more than 60,000 people.

Elise Sinha

“How we hardwired specific principles across the three is what differentiated us,” said Elise Sinha, senior director of operational excellence at HHC. “We have outcomes to show the value of the three systems working together.”

Principles in action

As early as Jan. 2020, HHC’s emergency management team started reaching out to Sinha’s process experts to craft a response to the emerging pandemic, Turek said.

“Our office recognized that something strange was occurring with this novel coronavirus,” Turek said. “We had perhaps a gut instinct that this was going to profoundly affect us. ... We needed to use project management and Lean to make sure our response was efficient, coordinated and aligned so that we could have successful outcomes across Hartford HealthCare.”

On the ground, the three systems interacted from the very beginning, starting with testing early in the pandemic for COVID-19 at HHC’s flagship location, Hartford Hospital. Staff process experts visited the testing clinics that served healthcare workers to study how supplies traveled from place to place, how staff members moved through the facility and other logistics. Ongoing adjustments were made to ensure clinics were operating at their highest efficiency as conditions evolved.

An in-depth study of early drive-through COVID testing sites, for example, found that more staff needed to be hired to guide drivers through the site and help patients book appointments by phone.

Staff then compiled a “playbook” of best practices for mobile sites that could be applied as testing expanded to larger populations and different venues across the state. In the pandemic’s first year, HHC conducted more than 910,000 COVID-19 tests.

The playbook was then adapted to the next phase of the pandemic — vaccine clinics.

“We were able to take that same playbook and just scale it up to a larger level — more patients coming through, more vaccines, more space. We were able to scale it up because we had hardwired what it should look like,” Sinha said.

HHC’s clinics were so efficient through staffing redeployment that the system became the largest provider of COVID-19 testing in the state. It has also been tapped to run several vaccination “mega-clinics.”

What took the scaling-up process beyond simple project planning was the discipline of Lean, Sinha and Turek agreed.

“It was all leveraging those same Lean principles,” Sinha added. “How do we remove any waste from the process? We did a lot of study-and-adjust, we did a lot of dry runs.”

In all, Sinha’s team prepared playbooks for 46 separate processes relating to pandemic response at HHC, including surging critical-care capacity, launching virtual health platforms, coordinating crisis media response and supplying personal protective equipment.

The bottom line is your local hospital or doctor’s office is increasingly looking to management principles to maximize efficiency across operations.

“The project management skill set is also increasing and evolving within the health industry,” Sinha said. “We’ve been building our practice and our model throughout every part of the organization.”

Preparing for the worst

The increased use of management principles in healthcare operations coincides with the growth of dedicated emergency response departments. HHC’s team is only five years old but coordinates crisis response across the system’s seven hospitals, 12 surgical centers and 144 medical group locations.

With that emergency infrastructure — along with a Lean-inflected culture of improvement and extensive management expertise in-house — HHC was well positioned as an organization to respond to the pandemic, Turek said. The system was able to continue most outpatient services throughout the pandemic’s second wave this fall in part thanks to improved processes.

“We were at a place where we had resources to be able to take some chances to respond to COVID-19. We were able to stand stronger than others,” Turek said.

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