Northern Physicians Organization: Lean Transformation to Improve Practice Improvement Capacity and Efficiency

Lisa Nicolaou, MSNI, BSN(1) ;  Peter Alvarado, DO(2) ; Heather Frazier, PhD(3) ; Deb Schepperly(4)

Author Affiliations:
(1) Clinical Process Analyst, Northern Physicians Organization
(2) Internist, Thirlby Clinic
(3) Training Specialist, Northwestern Michigan College, Training Services Department
(4) Clinical Quality Coordinator, Thirlby Clinic


Transforming healthcare is a favorite topic in our newspaper headlines and professional journals with promises of reformed care delivery methods and improved quality while reducing overall costs. There is no question that the system needs to change, and plenty of thoughts about how to make it happen. There is general consensus that the Patient Centered Medical Home (PCMH) model of care holds the greatest potential and requires a “robust, comprehensive and capable primary care foundation” (Gill MD, MPH & Bagley MD, 2013, p. 202) to effect system wide change. The foundation concepts apply well beyond primary care to the entire outpatient environment or patient centered medical community (PCMC) where the majority of patient care is provided. The collaborative effort of the full PCMC offers hope for sustainable and meaningful transformation.

The PCMH model of care is intrinsic for all physicians, nurses and allied health care team members; however, its adoption is impeded by complicated work patterns developed over years in response to extrinsic demands by the system, patients and payers, as well as by lack of methodology to effectively manage change. The use of multidisciplinary teams in healthcare allowing staff to work to their fullest potential is not a new idea. While new skills may be required to rediscover and re-implement these intrinsic good practices, once learned these skills will further strengthen the outpatient base of care, providing the foundation to adapt to future needs presented by the health system. With such skills organizations both large and small, become learning organizations capable of real transformation, rather than brief problem-oriented adjustments. Northern Physicians Organization (NPO) in Traverse City, Michigan believes that investment in the development of Lean thinking in autonomous practice settings is of prime importance to realize the goals of transformation and quality care for patients.

NPO is a physician-led provider organization representing over 500 physicians in Northern Michigan, assisting practices of all sizes in the move from fee for service to fee for value. The axiom of transformation is the precept that how care is provided must change. Successful and sustained change requires leadership (Gilley, Gilley, & McMillian, 2009). As part of this changing healthcare landscape, NPO recognized early on a need to build leadership and quality improvement (QI) ability from within autonomous practices that have traditionally lacked these abilities (Taylor, et al., 2013). NPO believes the practices it represents are well suited to Lean as a method for change management as it builds leadership and improvement skills in the people who perform the work through the entire vertical structure of the organization. This type of ground up approach is critical to empower staff members and shows significant promise in meeting the demands of the future both at the practice and provider organization level. As a Lean organization itself, NPO pursued a partnership with the Northwestern Michigan College (NMC) Training Services Department to bring the Lean thinking to independent physician practices. Leveraging the use of existing community infrastructure was important to NPO, rather than building internal infrastructure. Partnering with non-healthcare training division not only allows a non-biased perspective to take the lead through change but also allows NPO to continue to navigate the constantly changing needs for the practices while transformation occurs. One practice’s journey is detailed in the following case study.