November 3, 2006

Internal Medicine Associates: Learning from Toyota

As part of the MGH strategic plan, the hospital is piloting a process improvement strategy developed by automobile manufacturer Toyota. A key component of the Toyota Production System involves employees noticing what makes their work difficult and collaborating towards a solution. Often the answer involves many small changes that cooperatively improve workflow. Recently, the staff of the Internal Medicine Associates (IMA), an MGH primary care practice, used the approach to improve its process for handling telephone messages.

IMA secretaries collectively take up to 1,000 telephone messages a day. Prior to the process improvement initiative, practice secretaries used a "free-form" approach, collecting whatever information each judged to be necessary and writing the message out by hand. Many of the notes required reworking because they were illegible, lacked information or were relayed to the wrong person in the practice. Each message required approximately five minutes to take. Responses to patients often were delayed, and secretaries were occupied with the time-consuming task.

To address the issue, a small team of IMA staff, including secretaries, nurses and a physician, collaborated to improve the process. The team designed a prototype form that prompts the message taker to collect pertinent information by checking boxes on the form. Once in use, edits were made to the first version based upon feedback from the secretaries. Each revision improved and streamlined the message-taking process.

"I spent a lot of time on the telephone handling calls," says Tracy O'Neill, IMA secretary. "This took my attention away from other responsibilities that needed to be addressed here in our busy office. I like this new form. It has definitely simplified our work day."

Using the new message form, secretaries have been able to take messages more quickly and easily. Notes no longer lack information, and the time to take a message has been reduced by two minutes per call. Saving two minutes on each of the 1,000 messages per day has freed the equivalent of four staff members to attend to other work.

Look for more process improvement success stories in future issues of MGH Hotline. For more information, call Sally Iles at (617) 726-8283.