How to bring 'lean management' to your practice


"Lean management" is the latest buzz phrase among savvy medical practices that are trying to reduce costs while improving quality.

So what do patients value? According to a 2007 Consumer Reports study, the top five objections from patients have to do with time. Topping the list, nearly 25% complained of waiting 30 minutes or longer. The second greatest offense is not being able to schedule an appointment within 1 week. In other words, patients value timeliness in obtaining an appointment and a short waiting time in the reception room. For the most part, these practice shortcomings can be greatly improved by applying lean principles.

Lean management was first developed for the manufacturing industry, but the tenets apply to medical practices as well, starting with the "seven wastes" that compromise efficiency, quality, and profitability:

Inventory. Think of the extra steps incurred when a needed supply is not on hand or the lost revenue when expensive materials with a short shelf life end up being tossed because the expiration date has passed.

Extra process steps. Take an objective look at how many processes are really required to do a task in your office, remove the unnecessary ones, and retain those that bring value to the outcome. At a practice I visited recently, the receptionist was getting up constantly to photocopy both sides of each patient's insurance card, staple the pages, and place them in the patient's chart. The purchase of an inexpensive card scanner saved hundreds of steps each day and reduced patient check-in time.

Motion. This falls right in line with timeliness and delays. If a patient calls three times to get the results of a study, he has called two times more than he should have. The same applies when the urologist is in the exam room with a patient and pathology or lab reports that need to be reviewed with the patient are not in the file.

Defects. Claims rejections are the telltale sign of defective data entry or failure to update patient information. It's also evidence of inconsistent processes that result in adding steps that do not give added value. In other words, do it right the first time.

Waiting. The patient visit is a perfect example. How long is the patient in your office compared to the actual visit time? If the wait time is significantly longer than the actual visit, what are the reasons? By following each step, from the time of the patient's arrival until he departs the office, we can identify processes that may be unnecessary and recognize logical variances, based on specific circumstances or how a patient presents clinically.

Transportation. Think about how things are handed off in your urology practice, whether it's information, responsibilities, or supplies. Communication and accountability must be clear. If there's confusion, errors, or delays, you are not managing the hand-off effectively.

More recently, an eighth waste, underutilization of employees, has been added to the original list of seven. This addition stresses that, by capitalizing on employees' creativity, organizations can eliminate the other seven wastes and continuously improve their performance.

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