• Going Lean: How a Simple Change in Thinking Can Help Your Patients, Your Staff and Your Bottom Line

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    Ophthalmology practices must do more with less as they transition to value-based reimbursement requirements that place increasing emphasis on efficiency.

    However, a recent report by Harvard Business Review suggests that the practice of medicine is anything but efficient. According to the publication, “inadequate, unnecessary and uncoordinated care and suboptimal business processes eat up at least 35 percent — and maybe over 50 percent — of the more than $3 trillion that the country spends annually on health care.” That’s almost $1 trillion in waste.

    A figure that large is undoubtedly daunting. And chipping away at this type of waste in your own office is no less overwhelming. However, as two experts in practice management discuss below, the process is easier than you think. By implementing “lean” principles in your practice, you can boost patient flow and practice productivity — all while increasing your bottom line.

    What Is ‘Lean’?

    The lean philosophy is a powerful but simple management tool that focuses on creating the greatest value for customers by minimizing wasteful steps in your business process. It originated in the manufacturing sector, but can be applied to almost any industry.

    “When I describe lean management to people, I tell them it’s like making coffee in the morning,” said Robert E. Wiggins Jr., MD, MHA. “There are a number of different steps. How can you simplify each of these steps and make the best cup possible in the least amount of time, using the smallest amount of resources?”

    Lean can help small and large businesses — and both individuals and groups. In essence, you can apply lean anywhere there is a process. For ophthalmology, this can include:

    • Checking in a patient;
    • Collecting and verifying demographic and insurance information;
    • Ordering tests;
    • Tech and physician workflows;
    • Scheduling;
    • Coding and billing.

    And you might already be “lean” without knowing it. Have you participated in the Academy’s IRIS® Registry (Intelligent Research in Sight)? “This is a great example of .ean,” said Dr. Wiggins. “By automatically pulling information from patient records, the IRIS Registry works in the background without the extra work required of your staff to extract, measure and report quality data.”

    How Lean Benefits Your Patients

    Dr. Wiggins is the Academy’s senior secretary for ophthalmic practice. He’s also a managing partner at Asheville Eye Associates, a large, multi-office practice in North Carolina where he learned firsthand the benefits of going lean. Dr. Wiggins and his team looked at how the implementation of EHR could improve the practice’s efficiency and productivity and, as part of this analysis, evaluated how they were having patients check out.

    Rather than walking patients back to the front desk, the practice decided to have the scribes and technicians make appointments and post charges in the exam room. “It was time-consuming to move our patients around the office for tasks that can be accomplished in the clinic space,” Dr. Wiggins said. “Going lean in this regard ultimately saved time for patients and staff — everyone is happier.”

    Lean made Dr. Wiggins’ practice more efficient by simply reducing the number of physical steps his patients and staff took.

    “This is a perfect example of what lean means for ophthalmology and how it affects patient flow,” said Aneesh Suneja, MBA, president of FlowOne Lean Consulting LLC. Many patients today waste hours in the office because of both poor patient flow and excessive patient movement. Once they are checked in, a tech may not realize who’s responsible for which patient. As a result, patients end up sitting in the waiting room for longer than necessary. Once they are moved to an exam room, patients can face a wide variation in the screening process — for example, a tech may dilate one patient at the beginning of the screening process and another at the end. This creates confusion for other techs and physicians. In the worst of these scenarios, patients can be forgotten, kept in queues and severely delayed as they move from screening, imaging the exam and back to the front desk.

    “Lean addresses all of these issues by redesigning patient foot steps,” Suneja said. “This involves creating minimal movement of the patient and optimizing the location of a practice’s resources — for example, making sure that a piece of equipment such as an OCT machine is placed in close proximity to where it will be used.”

    Lean Also Makes for Happy Staff and Happy Doctors

    Going lean benefits practice staff, too. Yes, it’s primarily concerned with helping you provide great and efficient care for each and every patient. However, lean also helps create a positive work culture for staff and physicians.

    “It’ll come as no surprise that an inefficient and poorly run office can lead to a lot of finger pointing,” Suneja said. Patients complain about wait times and post negative feedback on the Internet. The front desk and techs blame one another for being too slow. The physicians blame the schedulers. In this type of practice, there’s always a crisis to resolve.

    “Lean really attempts to take this hostile work environment and shape a positive, healthy work culture for everyone involved,” Suneja said. “Physicians, staff and administrators will better understand how their workflows and responsibilities impact good patient care, and everyone involved will learn to respect each other’s roles and responsibilities.”

    Going lean can also benefit the youngest members of your team. “More and more practices are hiring millennials,” Suneja said. “These individuals want to be more than just a worker bee — they want to believe in the organization and have a say in it.”

    Lean allows for just that by involving staff in decision-making and giving everyone a voice. “Lean gives them the responsibility and engagement, quite honestly, that traditional organizational systems simply don’t,” Suneja said.

    Lean Is a Practice-Wide Collaboration

    Just as lean can improve the culture of your practice, it only works if everyone is involved. For Dr. Wiggins, the buy-in began with the ophthalmologists and administrators. “It’s important for those in leadership roles to first understand what lean is,” he said. “You have to get the doctors and the administrators on board before involving those on the front lines who may have the best ideas about eliminating inefficient practices and waste.”

    Once you do have this buy-in from leadership, ask your staff some simple questions. What changes would you like to see in your work flow? What’s taking you too long? What’s being wasted? What’s too complicated? How can we do better?

    From there, you’ll need to demonstrate how going lean actually works. Start with a small project — even if it’s an idea for a single patient encounter — and introduce it to those you trust will be the first adopters. After you and this group get some small successes under your belts, bring other people on board and show them how it works too. “The more successes you have, the bigger the projects can be and the more people you can get involved,” said Dr. Wiggins.

    The Bottom Line

    The benefits of going lean are clear. The ophthalmologist can see the same number of patients in less time while offering the same high-quality care. The staff can end their day on time with happy patients, no backlog and the satisfaction of a job well done. And working together as a team, everyone can eliminate waste and engender a positive work culture.

    But how will it affect your profit margin? The results are surprising.

    According to Suneja, an ophthalmologist can save an average of 30 minutes per clinic session after implementing lean systems. With this extra time, the ophthalmologist will be able to see one to two additional patients as well as accommodate additional emergencies.

    Here’s how it adds up:

    • Two additional patients per clinic session and four clinic sessions per week equals an extra eight patients per week and an extra 400 patients per year.
    • At $200 per office visit, these patients can result in an extra $80,000 of revenue per physician per year.

    The bottom line? “Over the course of 20 years,” said Mr. Suneja, “a practice may see an extra $1.6 million of revenue per physician.”

    Sound too good to be true? Find out for yourself how a lean transformation can work for you at these two upcoming AAOE events:

    • This month, Suneja hosts the Sept. 20 webinar, “Think Lean: Reduce Costs, Increase Profitability and Improve Patient Satisfaction.” The 60-minute session will take a look at some of the top lean techniques and help you tackle new payment initiatives, such as Medicare’s Merit-Based Incentive Payment System, and alternative payment models.
    • If you are attending AAO 2016 in Chicago, Oct. 15-18, be sure to check out “Mastering the Art of Lean Ophthalmic Practice” on Oct. 15. During this four-hour workshop, Dr. Wiggins and Suneja will help you create your own value stream maps — a powerful tool to analyze your practice’s current systems and identify ways to improve practice flow and patient experience.

    About the author: Mike Mott is a former assistant editor for EyeNet Magazine and contributing writer for YO Info and Practice Management Express.