Practical and Gemba

Let’s get practical. Applications of some of the tools we have talked about have produced some interesting results.

• A three doctor practice in the Houston area looked at their patient cycle time, improved their scheduling process, shifted tasks between staff members and were able to increase patient visits by four per day.
• Tools used: flow chart, run chart (we will see one later), brainstorming.
• A large practice in the mid west was reviewing their cash flow. The CEO simply used the “5 why” technique and found out that there was an automatic hold of 14 days on the AR. The reason given finally was that there was a problem with the billing system several years ago and that became the policy.
• Key tools used was the 5 why which came in a brainstorming session.
• A large oncology group decided to track compliance with care plans, which were developed and agreed upon. They monitored the results and determined that peer pressure and consequences were the best way to see improvement. Compliance increased from 35% to greater than 50% within three months and as of now compliance continues to improve.
• Key tools used was cause and effect diagram (we will see one later), flow chart, brainstorming, session with EMR vendor.

There are many more. One of the keys here is the involvement of the staff through brainstorming. It is not possible for one person to fix or solve all your problems. Utilizing staff knowledge and encouraging them to be involved is essential to the success of an efficiency program.

Another key term and concept in Lean is “Gemba” which literally means “the real place”. We think of it as the place where the work is done. It is essential that those involved go to the Gemba to see how, what, why, and/or when things are done.