title: The application of lean thinking to the care of patients with bone and brain metastasis with radiation therapy.
abstract: OBJECTIVE
  Patients with bone and brain metastases are among the most symptomatic nonemergency patients treated by radiation oncologists. Treatment should begin as soon as possible after the request is generated. We tested the hypothesis that the operational improvement method based on lean thinking could help streamline the treatment of our patients referred for bone and brain metastases.
  
  
  METHODS
  University of Michigan Health System has adopted lean thinking as a consistent approach to quality and process improvement. We applied the principles and tools of lean thinking, especially value as defined by the customer, value stream mapping processes, and one piece flow, to improve the process of delivering care to patients referred for bone or brain metastases.
  
  
  CONCLUSIONS
  The initial evaluation of the process revealed that it was rather chaotic and highly variable. Implementation of the lean thinking principles permitted us to improve the process by cutting the number of individual steps to begin treatment from 27 to 16 and minimize variability by applying standardization. After an initial learning period, the percentage of new patients with brain or bone metastases receiving consultation, simulation, and treatment within the same day rose from 43% to nearly 95%. By implementing the ideas of lean thinking, we improved the delivery of clinical care for our patients with bone or brain metastases. We believe these principles can be applied to much of the care administered throughout our and other health care delivery areas.
authors.affiliation: Departments of Internal Medicine, Pediatrics and Communicable Diseases, and Radiation Oncology, Division of General Internal Medicine, University of Michigan Medical School, Ann Arbor, MI.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Kim
authors.forename: James A
authors.initials: JA
authors.lastname: Hayman
authors.forename: John E
authors.initials: JE
authors.lastname: Billi
authors.forename: Kathy
authors.initials: K
authors.lastname: Lash
authors.forename: Theodore S
authors.initials: TS
authors.lastname: Lawrence