Pull

With you process map, value stream understanding, and goal of continuous flow, there is one more thing that is critical. How much work is done at each step along the way, how many resources are necessary to insure that work is “pulled” between steps instead of “pushed”. This basically means your staffing and work distribution should be such that when a patient has completed one step, the next step is ready for them, etc. The assembly line should pull rather than each step pushing.

This can be managed by doing a process map of each of the stops in the cycle. The smaller process map will tell you how many tasks, when the time required to complete that step is understood you can consider the staffing required. For example, the triage step requires vital signs, weight, reason for visit, and perhaps other activities in your practice. How much time is required for each activity to achieve the total time? Can each MA manage this step while the prior patient is in with the provider? Or will it be necessary for additional staff since there is more than one provider utilizing the triage station at the same time?

Continuous Flow

It is more efficient to have a nice day with positive flow. The assembly line should flow continuously with as few interruptions as possible. Here’s a question, asked previously but now is the time to really answer. How much time does the typical patient spend in your office? Most EMR programs have ways to record this data, pull a report by provider, location, and day of week. If you do not have that luxury, simply track the first established patient per hour per provider per location for one week. So for Dr. A at 9 AM on Monday established patient one checks in and checks out, record that time on a log. At 10 AM the first established patient checks in and check out. Do this for a week. This will give you the baseline to know the answer.