As a young business management student, I was intrigued by the research of Frank and Lillian Gilbreth, two early industrial engineers. I enjoyed reading about their efforts to help employees accomplish work faster and easier, which benefited the employers and the employees. They broke processes into their smallest component parts (which they named “therbligs” – Gilbreth spelled backward) and analyzed the need, role, timing and position of each therblig in the process. They experimented with each process, diligently measuring the outcomes, in pursuit of the “one best way” to accomplish each task and the process as a whole. The concept of improving methods to find “the one best way” to accomplish a process seemed to fit my personality and my view of the world. The search for and application of correct principles, processes and practices, as demonstrated by measurable outcomes, seemed like a rewarding pursuit – benefiting organizations, their employees, and those they serve. Such has proven to be the case.
Practice managers oversee the daily implementation of policies, processes, and practices. Oftentimes, it seems like our oversight involves just “keeping the lid on,” rather than a search for better methods. Still, our ability to continue meeting the needs, wants, and priorities of those we serve (both internal and external “customers”) requires a consistent effort to identify and implement better methods (e.g., faster, easier, higher quality, lower cost, etc.). Importantly, external changes in technology, in regulatory requirements, in competitive environments, and more, all require that we continuously change/update our methods. Failure to continuously review and improve our processes and procedures reduces organizational efficiency, damages the quality of our services, and makes our work harder.
Methods improvement can be a very sophisticated exercise, including specific time and motion studies and statistical process controls to reduce variation. Terms like Total Quality Management, Lean, Kaizen, Six Sigma, and others have found their way into the healthcare vernacular. Improving methods, however, can start out as a very simple exercise in engaging those doing the work in measuring and simplifying their work. We suggest the following steps for medical practice managers:
- Start Small: In order to win the confidence of decision makers and your employees, identify and start with small changes. Carefully track the “before” and “after” and celebrate small improvements, being careful to spread the credit for each success widely. Consider having a weekly “brown bag lunch” with those interested in performance improvement (physicians, other providers, and support staff). Use this small group to drive the selection of projects, to recommend priorities, to brainstorm performance improvement tactics, and to oversee the testing and ultimate implementation of performance improvement ideas.
- Strictly Measure Outcomes: It never ceases to amaze me how often we rationalize poor performance rather than pursuing and addressing the root cause(s) of poor outcomes. Critical to the success of any performance improvement method is an agreement to objectively and aggressively measure the outcomes of current methods (the baseline) and proposed improvements (the experiments). Your performance improvement group can help keep the process honest by strictly measuring the effectiveness of proposed performance improvement tactics. If those tactics don’t measure up, the group can select other tactics to try. If a medical practice is not experimenting with new tactics, it is not improving.
- Engage the Physicians and Staff: Those who endure the daily frustrations of broken or suboptimal methods are a great source of performance improvement targets. Ask your physicians and staff members for ideas that will make their work lives easier and improve the quality of the care and caring they provide. There are often more ideas than time or money to implement them, so also engage your performance improvement team (brown baggers) in recommending priorities to the physicians and other decision makers. Start at the top of the approved list and work your way down as far as budget and time constraints will allow, tackling only one or two items at a time. Often, the “fixes” are quite simple and inexpensive, as illustrated below:
On one occasion, we were asked to examine and help improve the productivity of certain physicians in a general internal medicine group practice. Interestingly, the lower producers were all located in the same side of the building. Also interesting was the fact that the physicians on that side of the building all complained about frequently not being able to locate their nurses upon exiting an examination room. Where were the nurses? They were on the other side of the office using the only available fax machine (remember those?)! A $150 investment in a second fax machine increased the productivity of the physicians and their assigned nurses.
- Look Around: Every medical practice is a laboratory of policies, processes, procedures, and outcomes, both good and bad. Other practices and their managers are great sources of performance improvement ideas and experience – many of which never make it into the practice management literature. Connecting with other managers and other practices leverages your performance improvement efforts through learning from the experience of those practices. Joining and actively participating in local and national professional management associations is a great source of new ideas and innovative practices.
For larger medical practice groups, engaging qualified outside experts can yield performance and financial returns many times the value of the associated fees. Adding just one patient a day or reducing effort to enhance provider productivity by a few percentage points, or streamlining the check-in experience, or eliminating an unnecessary task, or improving procedure coding, or increasing point-of-service collections – the list goes on and on – will make a dramatic and measurable difference in practice performance.
As continuous performance improvement becomes part of your practice culture, these and other performance improvement techniques can be applied to the areas of clinical quality, service quality, productivity and financial viability. Halley Consulting can help you establish and “hardwire” continuous performance improvement into your practice routine without the disruption caused by many of the more celebrated and costly performance improvement approaches.