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Palo Alto Medical Foundation Newsroom


PAMF Research Institute Wins AHRQ Grant to Study Efficiency Across Large Healthcare Systems

Lowering medical costs while improving care cannot be achieved unless improvements in healthcare efficiency made at a few pilot sites of an organization can be adopted at all sites. Recognizing this, the Agency for Healthcare Research & Quality (AHRQ) has issued a contract valued at more than $750,000 to the Palo Alto Medical Foundation Research Institute (PAMFRI). The money will fund a study led by Dorothy Hung, Ph.D., M.A., MPH, assistant scientist at PAMFRI, to analyze and disseminate PAMF’s effort to implement the “Lean” management system across the entire organization. This contract leverages ongoing work that Dr. Hung and her team are conducting as part of an internal evaluation of Lean at PAMF. 

Dorothy Hung

Dorothy Hung

Originated by the Japanese automaker Toyota Motors Company, the Lean quality improvement philosophy was selected by PAMF leaders as a way to further improve how the organization serves its nearly 800,000 patients in Northern California.

The idea of using principles originally developed in manufacturing for improving healthcare delivery may seem unusual. But the core idea of maximizing customer value while minimizing waste is applicable to any high-achieving organization that wants to become even better, said Dr. Hung. “Learning how to deliver better care at lower cost is critical to the viability of the U.S. health system,” she said. “With current pressures and expectations for healthcare reform, Lean is a promising approach to providing high-quality care at lower cost. Importantly, a crucial aspect of applying Lean to healthcare is its focus on value from the patient’s perspective. Thus, Lean fits well with PAMF’s long-term interest in its patients.”

The study starts in November 2013 and will examine numerous aspects of how Lean management principles are rolled out across the entire PAMF network, starting with its primary care departments. These include high-level metrics of affordability and cost, physician productivity, patient access to care, clinical quality indicators, and satisfaction among patients, physicians and staff.

The AHRQ grant will also allow for analysis of valuable data on frontline processes of spreading changes successful at the pilot sites to all of PAMF’s other primary care sites via an “adopt or adapt” model of transformation. Findings will be shared with healthcare organizations nationwide to help them learn what works and what doesn’t in spreading change throughout a large healthcare organization such as PAMF.

“Healthcare is in the midst of significant change, and it is vital that we demonstrate our value with a focus on measurement of outcomes,” PAMF CEO Richard Slavin, M.D., said. “We applaud the AHRQ for recognizing the importance of actively studying how changes are implemented across a large healthcare organization. With research data based on the actual experience of our organization, we will be better equipped to adopt changes system-wide that improve the health status of our patients as well as their satisfaction with our service.”

And the results could be even more far-reaching. “We expect our findings will be relevant for other healthcare organizations that will be facing similar challenges,” said Dr. Hung. “Our goal is to understand the Lean implementation process, impact on cost and quality outcomes, and factors needed for successful spread. We will share how our system-wide efforts ultimately transform how we deliver healthcare to patients.”

The research team will publish and circulate their findings widely through scholarly articles, issue briefs, guides and webinars so that other organizations can learn from the PAMF experience.