Sunday, June 19, 2011

Lean medical care

at 1:29 AM
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When I was 21, a pickup truck backed into me, knocking me down so hard that my glasses fell off and a class ring I was wearing flew off. I didn't think much about it, but later in life I started having some back problems. A friend referred me to a chiropractor.

I've been going to him for 15 years about twice a year when I get jammed up. He straightens me out.

Recently, I called for an appointment but he was out of town. His voicemail referred me to a nearby chiropractor. I called and made an appointment. While the treatment to straighten me out was pretty much the same, the experience was magically different. The new chiropractor runs a lean practice; my existing chiropractor runs a mass production one.

Current Chiropractor's Process

My existing chiropractor has you sign in and fill out a sheet describing your symptoms which takes five-to-ten minutes. His assistant then leads you into one of three examination rooms, where you wait.

In essence, he has a batch size of three. After the treatment, the doctor spends a few minutes filling out paperwork to be added to your file.

A typical visit takes about an hour. I didn't realize how unsatisfactory this was until I visited the new chiropractor.

New Chiropractor's Process

I arrived a few minutes before my appointment expecting to have to fill out some paperwork. Instead, the doctor was ready and I was immediately led into her single exam room. She asked me a few questions and then started the exam. When she finished the treatment, she immediately turned to a computer terminal and using a touch screen, entered her notes about my treatment (in essence an electronic medical record which means little filing). She asked me to fill out some basic paperwork on my way out. She suggested I do a followup with my chiropractor in about a week.

I was in and out in 15 minutes. I couldn't believe it. And she was $12 cheaper! Then I realized that she has a much smaller office (fewer exam rooms), so her fixed costs are lower. She uses electronic medical records, so her filing room is much smaller. I knew I had to get another glimpse into this operation. So, since my chiropractor was still going to be out of town, I scheduled a followup visit.

The following week, I walked in as the new chiropractor was finishing with her current patient. I was immediately led into the exam room. We talked briefly about my progress; she adjusted my back; I paid and I was out in 15 minutes. Wow! Now that's my kind of patient care.

With my existing chiropractor, I knew that if I arrived a little late, I'd still have plenty of time to do the paperwork and get in some reading. With the new chiropractor, I know that I'd better be on time. Her speed demands my timeliness without ever having to say anything, post any signs or sign anything.

Time is Money!

Medical care is no exception. My current chiropractor creates an assembly line with three patients in the queue at any time. Which means we have to wait 20-30 minutes in the exam room reading out-of-date magazines to fill the time while our back continues to spasm or be in pain.

I realized that my medical doctor also has a waiting room and numerous exam rooms to create a batch of three-to-five patients. It takes an hour to see her as well, even if you go first thing in the morning.

This new chiropractor understands the secrets of one-piece flow. One patient at a time, one exam room, and no "work" in process. Notes are entered immediately before you leave the room, not written on a piece of paper that needs to be filed.

So am I going to switch chiropractors based on my experience? Let's examine the data I've collected so far:

Current Doctor New Doctor
60 minutes 15 minutes

$12 cheaper!

I figure my time is worth a lot. I can do a lot in 45 minutes that I can't do if I'm sitting idle in an exam room. What would you do?

If you study any typical mass production doctor's office, you'll find that the doctor is always busy, but the patient is idle 90% of the time. To accelerate patient flow, you have to focus on the patient, not the doctor. You have to optimize the patient's time, not the doctor's. And when you do, you'll find that you get greater productivity and patient satisfaction, but you have to unlearn the mass production techniques of Henry Ford and embrace the simple principles of the Toyota Production System and Lean. The future belongs to those who embrace the principles of Lean and Six Sigma. Will your business be one of them?

Jay Arthur is a well-known expert in Six Sigma and Lean Six Sigma. Jay helps teams understand their communication styles and restore broken connections. Jay has 30 years experience developing software on everything from mainframes to PCs.

Jay sells QI Macros, books, consulting services related to Six Sigma and Lean Six Sigma. He has a Bachelor's Degree from the University of Arizona in Engineering, and a Master's Degree from Rutgers. He is a member of the National Speakers Association, Association for Software Quality and many other organizations.

Jay Arthur's latest books are; Lean Six Sigma for Hospitals (McGraw-Hill 2011) and Lean Six Sigma Demystified Second Edition (McGraw-Hill 2011)

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