A healthy body-what a wonderful thing! It is wonderful both for the patient and the physician. It is a well- integrated system of smoothly functioning parts. This marvelous organism allows the owner-the patient-to enjoy his life and participate vigorously in it. On the other hand, a body in which some ‘parts’ are not functioning well can cause a lot of problems. We in the medical field know this of course. What we don’t often realize is how much like an integrated body our office or medical site is. Is your site in great shape or are their chronic problems cropping up frequently?

In my experiences with primary care offices and hospitals I have found few in great health. I believe that one of the reasons is the medical view of quality. It is almost always focused on patient centered measures or clinical measures. For instance, in the highly touted book “Crossing the Quality Chasm,” most of the recommendations for improvement center on patient measures-transparency and timely delivery of care, for instance. In one group of healthcare providers that I communicate with most of the talk about quality focuses on delivery of care to chronically ill patients. From the perspective of the CEO of one local company which manufactures auto parts and which loans its Lean expertise to local hospitals, “They just don’t get it.”

So what do healthcare providers often miss? They don’t see that all the personnel at the healthcare site are an integral part of the delivery of care to the patient. Every employee has an impact on the delivery of care in some way, even if the employee never has direct contact with the patient. The quality of an office depends upon the integration of every employee into the effective delivery of care. For instance, how does someone in billing affect the delivery of care? If a significant proportion of the bills must be redone to get money from a payee, then the cost per bill goes up. There is wasted effort. The bottom line is affected. How does this affect the patient, then? Often healthcare providers cover this waste by increasing the workload of the physician, either by having the physician spend less time with each patient or by having the physician see more patients. Either way, the quality of care goes down. Let me give one word of caution here. It is too easy to blame the person doing the billing for the waste. That is not the correct approach, though. From the lean perspective, such waste is located in the system. Lean approaches would find ways to eliminate the waste without blaming the person doing the billing.

I recently encountered another example of failure to focus on a source of wasted effort. I was talking to the director of quality of a healthcare provider which provides primary care to patients. I asked if the doctors in the offices can always find the supplies they need. Are the supplies organized so they are in the same place each time? Are the supplies always replenished when they are low? She said that would be a miracle in their offices. If the doctor has to spend time looking for supplies then time is wasted that could better be spent on patient care. In manufacturing sites which apply lean principles, the placement and organization of supplies is part of a process named 5S (sort, set in order, shine, standardize, sustain).

Offices that apply lean to all the processes at their site are having good results. Recently I was reading on the iSixSigma website an article titled “Lean Improves Physician Office Medical Records Flow.” At this office it was found that staff spent an average of 7 hours a day looking for patient medical records that weren’t stored in the usual place. The record might be sitting on a physician’s desk waiting for a signature for a prescription, for instance. Using a kaizen event approach, the staff was able to cut the time to an average of 2 hours a day. This is a 71% savings. Imagine how the saved time could be put to better use.

Healthcare offices are not the only organizations failing to apply Lean principles to their whole work site. Many manufacturers only apply Lean to the manufacturing floor. Applying Lean principles to the office, though, results in significant savings, as illustrated in the example above. A recent article in the American Society of Quality’s “Quality Progress” titled “In the Office: Where Lean and Six Sigma Converge,” it was pointed out that in general an office applying these approaches could save on average 40% on process time for all its activities. Imagine how this time could be spent at your work site. There always seems to be too much to do and not enough time to do it in most healthcare settings. Lean can help you overcome this dilemma.

If you look at every process at your healthcare site as essential to the delivery of quality patient care, you will find many ways to improve. You can find there is more time to devote to patients. You will find that employees are much more satisfied with their work. You will find an improvement in the bottom line.

Donald Bryant helps healthcare providers meet their challenges. Go to http://www.bryantsstatisticalconsulting.com to get a free article with tips you can use to start making improvements immediately and to learn more about Lean Healthcare

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