Building a Factory Efficient Medical Practice By Reducing Non-Value Work
In the first article in this series, Improving Medical Practices by Adapting Manufacturing Processes, I illustrated some of the similarities that exist between how medical practice and manufacturers conduct business. To recap, medical practices and manufacturing factories perform three types of work. The first type is value-added work. This is work that customers are willing to pay for. In a factory, these are things like processes that transform the product from a raw material into the finished good. In a medical practice, doctors use diagnostic tests to identify the illness and then prescribe a treatment plan. The second type of work is required non-value added work. This is work that is necessary to conduct business but that the customer doesn’t really care about as long as it doesn’t interfere with receiving. Required non-value added work normally centers on legal requirements like continuing education and OSHA laws. Let’s move on to non-value added activities which usually represent the biggest opportunity to reduce waste in both medical practices and factories.
Non-value added activities or work are neither business critical or considered valuable by the consumer. These are pure waste activities that often times are a product of the way things have always been. Examples in a factory include things like transporting unfinished goods between one process and another because the two processes are laid out at extreme opposite ends of the factory. One very specific example I can remember from a project I worked on in college was a factory that built floor fans. One particular model had a bottom plate where a hole would be drilled before the final assembly. This hole had some fairly stringent specifications and would sometimes lead to rejection of the assembly during the final inspection process. There was no obvious use for this hole, so I started asking around to find out why it was drilled into the floor plate. No one seemed to know why. I finally looked at some old drawings of the fan and realized that in previous models, a wire would go through the hole into the housing. This wire had long since been removed in later models, but the hole was left inadvertently in the drawing. The factory continued to faithfully drill this hole into the bottom plate and inspect for the presence and dimensions of the hole at final inspection because no one ever bothered to ask why.
Medical practices also have a lot of non-value added activities that take place on a daily basis. Examples in a medical practice are things like documents that a patient fills out at check-in that never get reviewed by the doctor or medical assistant, or running a diagnostic test “just in case” the doctor might need it when she gets into the exam room with the patient. Non-value added activities are the waste of “just in case” or “just because we’ve always done it that way.” Non-value added activities are sometimes put in place as a reaction to something that happened a long time ago that caused an issue but remain in existence even though the issue no longer exists. Factories spend a lot of time trying to eliminate this work altogether. The toughest part of identifying non-value added work is confusing this work with required non-value added work. Many factories and medical facilities that I visit try to rationalize this work as something that is required. Don’t be afraid to challenge popular belief. It might not be as required as everyone thinks it is.
Factories work hard to make it easy to identify when something is out of place. This helps a factory easily determine the presence of non-value added work. They do this by designing a visual workplace. When you walk through a factory, you can very easily tell when a pallet is out of place because there is red tape on the floor identifying where it should be. Knowing that the pallet is out of place immediately gives you an indication that something in the process isn’t working the way it’s supposed to. Similarly every tool has a place. You can tell when a tool is missing because there is an empty space in the shape of the tool on the board where the tool was supposed to be hanging.
In a medical practice you cannot mark everything with red tape but you can use visual clues to determine whether something is out of place. A great place to start is the waiting area and the exam rooms. If the process is working smoothly for example, you shouldn’t walk out to the waiting area and see 6 people sitting there waiting to be seen. By the same token, as a doctor you shouldn’t walk out of the exam room to see four more exam rooms with closed doors and flags sticking out with patients waiting for you. All of these things provide you with indicators that something isn’t working as it should. The key is taking a little bit of time to dig in and find out what’s going on. Over time you will establish patterns that will lead you towards where to make improvements.
Also Read: Improving Scheduling in a Medical Practice
Factories study their processes intensively in order to seek out the various sources of waste. One great tool that factories use to study the process is a video camera. Factory employees will record different processes on video and then use the video recordings to build process maps that illustrate each process in detail. Video allows you to shortcut observation time by enabling you to focus on the process while cutting out all the extraneous activities that are taking place. One great benefit to video analysis is the ability to play the video over and over again to establish patterns. Video analysis can also be a very powerful yet non-traditional to study the process in medical practices.
Many medical specialties have situations that would be highly sensitive to video analysis but that shouldn’t stop practices from videotaping and analyzing many of the non-patient facing activities such as scheduling, insurance eligibility verification, and billing processes. Many patient facing situations can also lend themselves well to video analysis as long as permission is obtained from the patient ahead of time and all the right HIPAA documentation is in place. You would be surprised how many patients don’t mind being videotaped if they know that the practice is trying to do its best to analyze the video for the purposes of providing a better patient experience.
Many differences exist between the production of widgets and caring for patients in a medical office. However, there are many similarities that present an opportunity to learn something from another industry. Factories have been honing and streamlining processes since the beginning of the industrial revolution. There is a lot to be learned and applied in a medical practice that factories do extremely well on a day to day basis. Keep the positive changes coming and don’t be afraid to venture beyond the borders of healthcare to search for solutions.
About the Author
Tony Milian is a Managing Partner at Practice CoPilot, which provides real time location systems and lean consulting services designed to manage patient flow in medical practices.