Implementing Lean in a Physician Practice

The first step toward implementing Lean in a physician practice is to assess the current work flow. It's crucial to first understand the practice's current state and the minutiae of what is going on in its environment.

"By that, we want to look at what are all the activities that go on to provide that service to the patient," says Larry Coté, president of Kaizen Institute Lean Advisors in Ottawa, Canada. "We look at information flows as well as patient flows and understanding all those activities from end to end."

Keeping track of analytics is of equal importance, says Frank Cohen, MPA, senior analyst at MIT Solutions in Clearwater, FL.

Cohen recently worked with a physician group that had just begun using an e-prescribing service because it wanted to reduce prescription errors. When he asked the group by what percentage errors had been reduced, practice leaders said they did not take any measurements.

"People who do Lean tend to ignore the analytics—the metrics—and that's where I think practices could improve significantly," Cohen says.

The two most common areas for improvement in physician practices are the patient flow and billing processes, Cohen says. "There are so many steps involved when a patient checks in and checks out, and the steps have so much waste associated with them."

After analyzing the patient flow at one practice, Cohen found that there were about three minutes wasted per patient visit. The practice managers scoffed at him, thinking three minutes wasn't so bad, until Cohen did the math for them.

Assuming they see 80 patients per day and waste three minutes with each, that adds up to four hours of wasted time. If the practice managers could shave off just one minute from each patient visit, and they generate $100 revenue per visit, that would give them an additional $2,000 per week in revenue. In many cases, this can be done by eliminating redundancy during check-in, Cohen says.

After the problem areas have been assessed, you should lay out an action plan for improvement. Coté calls this plan the "future state," which shows how the practice would ideally run once all of the nonvalue (wasteful) processes are removed. Although practices should not expect to reach this future state right away, it's helpful to give them a vision and strategy for the direction of where they are headed, Coté says.

Next, Coté suggests drafting a future state that sets goals for the coming months. When planning, Coté and Cohen caution that practices should carefully prioritize the processes they are going to attack. If they solve the front end of a process before resolving issues on the back end, it only creates another bottleneck.

Once you choose the areas you want to improve, the only thing left to do is go after them, Cohen says. And you don't necessarily have to work with a consultant to do so. "A lot of practices don't have the resources to go through this Lean Six Sigma stuff," he says. "A lot of times you are the team. You do your best at being able to get the people together that need to be involved."

But if you do enlist the help of a consultant, it's imperative that a practice stakeholder is the one who actually implements the changes. "Never have a consultant make the changes," Coté says. "Have them keep you on track and help you make changes properly, but the actual changes and ideas need to come from people who work in the system."

By committing time and resources, it's possible for a physician practice to go it alone.

"The other consultants probably don't want me to say it, but there's a lot of common sense involved in this," says Cohen. "There's a lot of restructuring in what you do. In some practices, it may be more efficient to bring someone in somewhere along the line to bring education, but most practices can handle it on their own."