Hidden Healthcare Capacity — learn from lean manufacturing

conveyorbeltHealthcare in the past has shunned “conveyor-belt” surgery, “cookie cutter” treatments and “cookbook medicine”.  But, the disdain for efficiency, as honed by manufacturing, has put the spotlight on medicine and surgery as very inefficient with a huge hidden or wasted capacity.  Patients and healthcare providers are asking for the training of more healthcare professionals — they can’t manage the wave of baby-boomers needing care or the influx of new patients using the methods of the past.   So, let’s not use the methods of the past, it’s time to learn from industry, from Toyota, from Ford.
The key principle is “lean” —  definition of Lean, as developed by the National Institute of Standards and Technology Manufacturing Extension Partnership’s Lean Network:

“A systematic approach to identifying and eliminating waste through continuous improvement, flowing the product at the pull of the customer in pursuit of perfection.” 

Here is a translation for healthcare:

“A systematic approach to identifying and eliminating waste through continuous improvement, providing health care as needed by the patient in pursuit of perfection.”

 Here are the 8 “wastes” to be eliminated, as might be applied to a medical office:

  • Overproduction — From a medical office standpoint this is excess staff at certain times — indicated by an appointment schedule that is not full.  Staffing must be adjusted to patient load.
  • Waiting — Patients waiting for appointments, providers waiting for test results.  Ideally the when patient arrives  the provider is ready to begin.  Needs to be monitored with visual controls all the time.  Solving patient problems on the phone prevents clogging the system with unnecessary visits and reduces excess inventory.
  • Transportation — equipment (like gowns and syringes) need to be at the point of use not transported around the office.
  • Non-Value-Added-Processing (reworking) — having to review patient data because the problem was not resolved initially.  Sometimes multiple workers collecting the same information (very common when patients are admitted to the hospital) And, excessive medical documentation, a common problem with speech to text systems.
  • Excess Inventory —  No room in the appointment schedule because it is all filled up, patients want to be seen but no staff are available.  Represents a failure to hire adequate providers and staff.  Larger organizations are better able to make staff flexible, like sending them to a branch office if several staff are missing due to vacations or illness.
  • Defects (do it right the first time) — Following evidence based guidelines and using checklists reduces error in treatment and diagnosis.  Errors may result in legal action.  But, less severe errors end up requiring correction or at least explanation.
  • Excess Motion (poor workflow and documentation) A huge problem.  If offices don’t have labs, x-ray, a pharmacy, physical therapy, and commonly needed specialists it causes wasted patient and staff time.
  • Underutilized People — offices don’t often let nurses or scheduling departments make common sense changes.  Small offices fail to hire computer consultants or patient educators.

Much of the waste currently is due to lack of scale for many providers — they just don’t have big enough facilities.  Also, on a larger scale many towns have excess capacity in certain specialties.  Like supporting one neurosurgeon when all the neurosurgery should be done at a regional center to keep the providers busy and competent.  Likewise, not every hospital should be a high level trauma center.  Not every town or hospital needs a cancer treatment center.

Simply treating more patients over the phone is probably the greatest method to find hidden capacity.  If a visit is just to consider a blood sugar record that can be done without an office visit.  The second best efficiency boost is to incorporate NPs and PAs as team members.  Third, a high functioning computer record helps to prevent reworking and reduces excess motion.  Above all, constant monitoring of efficiency and quality with continuous improvement is essential.

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