lean & meaningful workflow redesign

© 2010 The Detail Person LLC

Lean and Meaningful Workflow Redesign

Pat SchererCEO, The Detail Person LLC


Why Bother with Workflow Redesign?

Catch Errors Before They Happen

Control/Reduce Costs

Do More with Less

Satisfy the (Im)patient

Prepare for EHR Installation

Improve Communication


Process List

Recording Workflows

Workflow Diagrams

The 7 Wastes

Other Tools

Summarize Workflow Redesign Process

Workflow Redesign Basics


1.Patient scheduling

2.Patient check-in

3.Patient exams, procedures and clinical recording

4.Patient check-out

5.Referrals

6.Call handling

7.Prescription refills

8.Claims and billing

9.Lab orders

10.Patient follow-up communications

11.Wellness/outreach

List Processes

4


Action Who Start Stop Elapsed

(min)

W Notes

Check-in P1 7:28a 7:32a 4 ? Queued behind 2 check in.

Fill out forms P1 7:32a 7:44a 12 ? Could forms be stream-lined?

Wait in waiting room P1 7:44a 8:00a 16 W Why?

Move to exam room P1/MA 8:00a 8:02a 2 ? Efficient layout?

Wait in exam room P1 8:02a 8:10a 8 W Why?

Take vitals & info P1/MA 8:10a 8:16a 6 ? Has to retrieve “good gauge” from another

room

Wait in exam room P1 8:16a 8:28a 12 W Why?

Exam P1/MD 8:28a 8:44a 16 ? MD repeats questions asked by MA

Wait to check out P1/R1 8:44a 8:50a 6 W R1 finishes a call, searches for patient folder,

finds it left in exam room

Check-out P1/R1 8:50a 9:00 8 ? R1 has difficulty locating copay info, takes

another call, printer is in another room

Total elapsed 90

Recording the 15 Minute Office Visit

T

h

e

1

5

m


?

Start (1st process step)

Process step

Decision

Document Data

Predefined process

End (last process step)

Workflow Diagrams


1st Visit?Yes

Move to room

Forms

Vitals

Exam

Office Visit Workflow

Check in

Check out

No


Over-production

Too much or too early


Unnecessary Stock

Stashes of inventory and

supplies; “stuff” waiting to

be worked


Inefficient Transportation

Moving people,

information and “stuff”

from one place to

another.


Unnecessary Motion

Unnecessary movement

or strain including

walking, bending,

reaching and twisting.


Waiting

Delays caused by

shortages, approvals or

downtime.


Rejects & Defects

The costs associated with

making and correcting

mistakes.


Inappropriate Processing

Stuff we do that doesn’t

add value to the patient.


Swim Lane Diagrams

Value Stream Maps

Layouts and Spaghetti Diagrams

A3 Implementation Plan

Other Tools


Swim Lane Diagrams


Value Stream Map

Move to room

Forms Vitals ExamCheck in Check out

R1

PT: 0.1

WT: 1.9

WT: 2 min

PT: 8

WT: 4

MA

PT: 2

WT: 0

WT: 16 min WT: 8 min WT: 12 min WT: 6 min

MA

PT: 4

WT: 2

MD

PT: 14

WT: 2

R1

PT: 2

WT: 6

2

M

T

M

M

Total PT: 30.1

Total WT: 59.9


Spaghetti Diagrams

Lab Exam 1 Exam 2

MD OfficeBillingCheck

InWaiting

MA

Patient

MD

Legend


A3 Problem Solving Format


Workflow Redesign Process Summary

Identify Processes

Record Workflow

Diagram Workflow

Identify Waste

A3: Plan, Do,

Measure Continuous

Improvement


Links “Lean Health Care: Lower Costs, Better Outcomes”, Wharton Health

Economics; 11/11/2009

http://knowledge.wharton.upenn.edu/article.cfm?articleid=2374&specialid=95

NHS (UK) Tools & Techniques http://www.tin.nhs.uk/index.asp?pgid=1134

DIY Lean (free A3 templates)

http://www.diylean.com/A3%20Materials/A3_Materials.htm

Presentation slides and other resources

http://www.thedetailperson.com/resources

Books Hadfield and Holmes, The Lean Healthcare Pocket Guide; 2006

Chalice, Improving Healthcare Using Toyota Lean Methods: 46 Steps for

Improvement; 2007

Jimmerson, A3 Problem Solving for Healthcare: A Practical Method for

Eliminating Waste; 2007

Jimmerson, Value Stream Mapping for Healthcare Made Easy; 2009

References


Questions?

Contact:

Pat Scherer

The Detail Person LLC

www.thedetailperson.com

512-415-3473

[email protected]

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