Lean Six Sigma: How process maps can improve practice productivity

Frank Cohen, MPALean Six Sigma (LSS) is a process mapping strategy that helps businesses become more efficient. Here’s how implementing LSS as part of your strategic planning process can help your practice save time and money.

LSS offers a way to improve your practice that combines statistics to measure and validate change and waste reduction to improve workflow and increase efficiency.

Many hospitals are requiring physicians and staff to complete LSS training at various certification levels. But is LSS an effective model for improving efficiency within a medical practice?

LSS in action

In one primary care practice I worked with, patients were reporting a high level of dissatisfaction at the wait time to see the physician.

A study revealed that the bottleneck was for new patients only and the reason was because new patients were not showing up early enough to complete the new patient intake forms. The practice conducted a test where they sent, by mail, new patient intake paperwork to 30 patients. The first group of ten were not given any reminder calls. The second group received one call 24-hours prior to the visit. The third group received two reminder calls, one at 48-hours prior and one at 24-hours before the visit. 

The results showed a statistically significant difference between the first and the second group, there was not much difference between the second and the third group. 

Because of the results, the practice decided to mail intake packets to all new patients with one follow-up reminder call 24 hours prior to the visit.  This reduced the average wait time for new patients by 17 minutes and for all patients by 12 minutes, exceeding the practice’s goals.

Building a team

LSS can be used to improve clinical quality and business processes, as long as two core concepts are observed. The project process must be reasonable (scaled to the size and resources of the organization), and it must have support from upper management.

I use a continuous five-phase plan of change, with a “day zero” that calls for selection of the team. There are many important components to team selection too. When I create a team, I focus more on diversity than ability.  I require each person to write down his or her skill set and reasons for participating. Duplication of heuristics and skills doesn’t add to the purpose of the team, and it fosters an environment of chaos, confusion and conflict.

The five-phase plan of change is detailed below.

1. Classification

Phase 1 is encapsulated in the process of discovery.

First, focus on educating team members on the concepts and processes of LSS. Second, begin with a SWOT (strengths, weaknesses, opportunities and threats) analysis and include both training and execution of process mapping and creating a work-flow for the process being examined for the change, such as wait times.

2. Correlation

Review the current-state map created in the first phase. Focus on measuring the process steps through data collection and analysis, perhaps the most time-consuming phase in the process.

Create a prioritization of projects, since we are all bound by the tyranny of the budget.

3. Causation

Get to the root cause of the issues that are discovered during creation of the process map.

We are looking for the real reasons behind waste in the form of bottlenecks, constraints, replication, duplication, and confounding events. For example, just because you see a decrease in revenue associated with a change in payer mix doesn’t mean that the change in payer mix caused the revenue decline. If you can’t figure out the root cause of a problem, you won’t find the solution.

4. Collaboration

Begin collecting possible solutions and testing those that can be tested.

For example, having identified the intake form as one cause of extended wait-time for new patients, you can create a couple of different modifications to the form and see which, if any, may be a viable solution. Collect a manageable list of possible solutions, test them, and create a plan.

5. Culmination

Finally, implement the recommendations and measure the impact. If it works, great. If not, re-evaluate goals and the process to figure out what, if anything, went wrong. It is also important to determine what went right and to set up for the next project.

Take time to do this process. Stretching the process to 90 days can  mean a much higher rate of success. 

Link to this article:

http://medicaleconomics.com/six-sigma-how-process-maps-can-improve-practice-productivity