08 Jan Orthopedic Practice Uses Unique Approach to Improve Delivery of Care
Dr. Chiodo says that “lean” is a process which allows you to “observe, assess, and implement small but discrete changes that can be measured. We designate certain days for observation. We spend a couple of hours observing ourselves and the patient experience, and then we sit and review and discuss what we’ve learned, but without stopping the patient flow.” Lean manufacturing was originally developed by highly successful companies like Toyota and Alcoa, which discovered that the more closely they observed their systems, and the smaller the steps they took to improve them, the greater the quality of their product and the efficiency of production. Funding comes from a grant arranged, in part, by a patient who wanted to encourage improvement in patient wait times.
With a variety of inexpensive improvements, the team reduced patient wait time from an average of 40 minutes to 29 minutes. One exercise was the “paper airplane assembly line” during which participants learned how to look closely at individual responsibilities and reallocate tasks as needed. “What made this exercise hard in the beginning was ambiguity,” says Maynard. “None of us knew how to make this particular paper airplane, nor which part of the airplane we should each be trying to make.” So the team learned to observe themselves in operation and how to balance the work load at each station. By establishing an efficient process, they were able to achieve quality, use time well, and reduce noise level and stress—all worthy ambitions for orthopedic teams as well as paper airplane makers.
Now, says Ms. Maynard, “People are learning how to stop and analyze a problem, rather than working around it. They ask questions, talk to each other, and look for root causes.” By November, the orthopedic team had begun to see a difference in the patient experience, and in their own experience as well. One goal was to reduce the wait time between patient arrival and the actual clinic appointment to less than 30 minutes, allowing time for an x- ray. Patients had been requested to arrive 60 minutes before the appointment, but observation revealed an average wait time of only 40 minutes. With a variety of inexpensive improvements to procedure and equipment, the team was able to reduce the wait time to 29 minutes. As a result, it took only an 11-minute reduction to reach the 30 minute pre-clinic arrival time. Another difficulty concerned patients bunching up at different points during their visit. The team took a look at the check-in and check-out procedures and saw that at a single desk one person was checking patients in and out, answering the phone, and arranging future appointments. The team came up with small changes that could be made one at a time to smooth patient flow. They set up separate desks for checking in and out, removed the telephone from the check-in desk, and assigned check-out to a second person. They flagged a passing maintenance man and asked him to remove an unneeded door that was blocking the check-out desk. They interviewed the check-out staff to find out what took them the most time. The response: making MRI and CAT scan appointments, some of them not needed for months. The solution: bundle these appointment requests and complete them during quiet times of day.
Dr. Chiodo points out that the close observation of lean techniques can involve large changes as well as small. The orthopedic clinic has, for example, ordered computer tablets that will reduce the use of paper records and give physicians more time to be with their patients. Both Dr. Chiodo and Ms. Maynard recognize that it can be a challenge to change ways of thinking about process, especially when medical care itself is working well. They emphasize, though, that care itself is not at issue. Their goal is, rather, to improve the experience for patients and staff alike. The lean approach is helping them move toward a quieter, more comfortable clinic environment with smoother operations and staff free to concentrate on patients. In the long run, they believe that a comfortable patient with less stress is going to be a healthier one.
– Rafi Benamoz, CEO, Benamoz Business Entrepreneur Solutionz
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