Implementing Lean Methodologies at Your Medical Practice

Because regulatory demands on private practices are exponentially increasing, the need to work effectively to maximize resources and improve quality of care is magnified. One way for practices to do this is to adopt "lean methodologies."

Lean thinking is a philosophy that aims to enhance operations through continuous process improvement, standardizing processes, and eliminating waste.

Roger Gerard, PhD, is an executive business partner with ThetaCare, a healthcare system in northeast Wisconsin. He has over 38 years of experience leading management development initiatives in healthcare, manufacturing, and service industries.

Physicians Practice recently spoke to Gerard about his upcoming session at the
Medical Group Management Association's Annual Conference in San Diego, "On the Mend - Embedding Lean Thinking in the Healthcare Culture." It is scheduled for Wednesday, Oct. 9.

Q:Lean thinking has been around for quite some time. What makes this approach especially relevant for the challenges that healthcare is facing today?

A: Healthcare costs too much. It's becoming increasingly unaffordable for people to pay what they're paying. Unless we take the waste out, unless we take those things out of the processes and systems that are not value-added to the people who are buying our services, this entire industry is going to be in a heap of trouble.

Q:You've said that you think it is important for practices to analyze these broader issues and ponder how they affect revenue, quality care, and patient satisfaction. Why do you think that's important?

A: The work going on in [private] practice medicine is part of a larger ecosystem. The ecosystem is the entire healthcare industry, and that includes not just practices but hospitals, long-term care, home health, technology - the ecosystem is very complex.

If we are practicing in an environment where we do not understand the ecosystem within which we thrive, we are not going to thrive for long. We have to understand that we are all interdependent, and as we do our work we can't just operate in isolation. If we don't get this, we are going to be a whole bunch of small fiefdoms, trying to compete with one another and take business away from one another.

Q:If practices realize this and they want to make some changes in how they do things, how can lean thinking improve the processes they use in their practices?

A: To get started, you have to experiment [and] try some simple things. Lean methods go all the way from very simple "let's get organized," "6-S" [a lean tool] processes to very complex, value-stream mapping and looking at the core products of your business.

So, if you look at lean as a whole enterprise process, then what you are doing is putting the entire business under scrutiny and looking at how the processes work together and how they don't. You are going to start methodically over time applying rigorous improvement methods to resolving the problems that exist.

It is also about creating standardized practices so that you can predict the quality of the care that you are delivering, over time, and become consistent in the delivery of that quality. The more consistent you are, the more you are able to affect the processes and make large scale improvements.

Q:I think sometimes there's resistance from the staff, and also physicians, when they are asked to standardize or give up their favorite way of doing things. Do you see that as a big problem in this type of initiative?

A: It's a common problem. And it's because there's a lack of understanding. If [staff and physicians] come in to the process thinking, "Lean is mean, you are going to make me do all these things I don't want to do," you've set yourself up for resistance right from the beginning. If you come in to this process understanding that lean is nothing more than the scientific method - you identify a problem, you begin experimenting, and you begin managing changes in the process - that's pure scientific method.

Q:When you talk to practices, how do you recommend that they get started? Should the practice manager take this under her wing and start the ball rolling?

A: If I can partner a very interested physician with a very interested administrator, I'm going to partner them in a heartbeat. Because you want both: You want the administrative point of view and the clinical point of view. And when you create that partnership then you can start experimenting together. I would start with small experiments, not big ones.

I would do something as simple as looking at supplies in a practice and how can we do a much better job in making sure that staff have the supplies they need, when they need them. If every exam room is organized the same way with standardization, that makes life easier for the physician, it makes life easier for the nurse, it makes life easier for any other support staff that is accessing that room.