title: Leveraging lean principles in creating a comprehensive quality program: The UCLA health readmission reduction initiative.
abstract: BACKGROUND
  UCLA Health embarked to transform care by integrating lean methodology in a key clinical project, Readmission Reduction Initiative (RRI).
  
  
  METHODS
  The first step focused on assembling a leadership team to articulate system-wide priorities for quality improvement. The lean principle of creating a culture of change and accountability was established by: 1) engaging stakeholders, 2) managing the process with performance accountability, and, 3) delivering patient-centered care. The RRI utilized three major lean principles: 1) A3, 2) root cause analyses, 3) value stream mapping.
  
  
  RESULTS
  Baseline readmission rate at UCLA from 9/2010-12/2011 illustrated a mean of 12.1%. After the start of the RRI program, for the period of 1/2012-6/2013, the readmission rate decreased to 11.3% (p<0.05).
  
  
  CONCLUSIONS
  To impact readmissions, solutions must evolve from smaller service- and location-based interventions into strategies with broader approach. As elucidated, a systematic clinical approach grounded in lean methodologies is a viable solution to this complex problem.
authors.affiliation: University of California, Department of Medicine, Los Angeles, USA. Electronic address: nafsarmanesh@mednet.ucla.edu.
authors.forename: Nasim
authors.initials: N
authors.lastname: Afsar-Manesh
authors.affiliation: David Geffen School of Medicine at UCLA, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Lonowski
authors.affiliation: University of California, Department of Medicine, Los Angeles, USA.
authors.forename: Aram A
authors.initials: AA
authors.lastname: Namavar
mesh_terms: D000046:Academic Medical Centers / Q000458:organization & administration / Q000592:standards / Q000706:statistics & numerical data; D002140:California; D006801:Humans; D010359:Patient Readmission / Q000706:statistics & numerical data*; D058996:Quality Improvement / Q000639:trends*; D060891:Root Cause Analysis; D012941:Social Responsibility; D017749:Total Quality Management / Q000379:methods*