Lean Management for Your Practice

Lean Manufacturing/Management is an approach to managing processes in a business. It was developed by Toyota to help eliminate gaps in the process of making cars. If there are delays in the assembly of the car at any point in the process it impacts the total time that it takes to make that car. This lack of efficiency costs time, money, and may result in a poor quality product. The same philosophy can apply to a medical practice.

It is important for you to "think business" as you look at your medical practice. It is also important to recognize that there are many processes in your business where delays are costly in terms of time, money, and patient satisfaction. These include scheduling, cycle time (time that a patient spends in the office), and billing.

The basic principles of Lean Management are:

• Identification of a problem area or goal for improvement;
• Measuring what the current state is as a base line;
• Determining what is wrong or what can be improved;
• Developing an approach to make things better; and
• Implementing these changes.

Once you've identified your problem area and the steps you will take to implement changes, then in a few weeks or months, you will measure what is now your new current state to see if there has in fact been improvement.

So, how would you apply Lean Management to your practice?

For example, let's say you are having trouble with your cycle time. You are receiving complaints from patients directly - or through your patient satisfaction survey - that they have to wait too long to see the doctor. So you want to take this on as a lean project. You first assemble a team: which includes the receptionist, a medical assistant, a doctor, and the office manager. They decide to follow and record the first patient each hour, for each doctor, for one week, to find out how long it is from check-in to check-out. The results are an average of 55 minutes for established patients. Together your team sets a goal to reduce cycle time by 10 percent or 5.5 minutes.

You then look at the process and decide that there are five basic steps: check in; triage or prep; the physician visit; the post-visit plan and implementation; and check out. Your team brainstorms together and determines that the main area of focus should be delays in the prep area which include: vitals; weight; documentation; and room prep. You agree to change a few things and see what happens.

Three months later you measure again and find that the average cycle time is now 51 minutes for established patients. Not quite on goal but better. Your team agrees to work toward continuous improvement, but this time you not only want to check the overall cycle time, you now measure each of the four steps. The results indicate that the area that has the biggest delay is check-in. So you choose to look at that, decide on some changes, implement those changes, and later measure the results.

The next measurement shows improvement in the cycle time by five minutes, so you are now at 46 minutes. You believe you can reduce it even more, so you go through the same process again.

Does this sound complicated? It really isn't since you are doing a random sample of a few patients. But what is happening is that you are beginning to "think lean" and the results are showing in improved patient satisfaction scores and reduced patient complaints. Your staff is happier, and everyone is getting home earlier! Another benefit is that you can put your "gained" time to better use, such as promoting a marketing campaign for your practice.

Whatever area of your practice needs improvement, consider lean thinking as a way to get the most out of your time - your patients, staff, and practice will be glad you did.

Owen Dahl, FACHE, CHBC, is a nationally recognized medical practice management consultant and author of “Think Business! Medical Practice Quality, Efficiency, Profits,” “The Medical Practice Disaster Planning Workbook,” and coauthor of “Lean Six Sigma for the Medical Practice: Improving Profitability by Improving Processes.” He can be reached at odahl@owendahlconsulting.com or 281 367 3364.