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  • Going Lean: How to Get Staff Buy-In

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    With the increasing emphasis on value-based care, busy practices face constant pressure to do more with less. No one knows this better than Amanda Mestler, COT.

    As a practice administrator at Duke Eye Center, she faced one of the more challenging tasks of her careers. A few of Duke’s satellite clinics weren’t running well. The patient flow wasn’t efficient and physicians and staff weren’t happy. In this interview, Mestler shares how they laid the groundwork.

    AAOE: How were you able to get staff and senior leadership to take the plunge?

    Getting buy-in wasn’t difficult because we were all ready for change and ready to embrace it. A few of our satellite clinics at Duke Eye Center weren’t running well, and physicians were unhappy. They empowered us to make changes and supported our involvement.

    But if you’re considering lean management for your own practice, you need to remember that change can be hard for people. So you really have to stress to physicians and staff that the end game will be worth the growing pains.

    And it really takes the entire team. It can’t just be the staff. Physicians have to be willing too, and that can be difficult because they might not want to give up control over the team. But that’s essential: The team as a whole needs to lead the practice through lean changes.

    AAOE: So your implementation of lean management wasn’t a top-down approach?

    Definitely not. The lean process can’t be top-down because nine times out of 10, the top doesn’t realize what’s going on with the bottom because the top isn’t always in the trenches with the bottom.

    To enable a more holistic approach at Duke, we had a brainstorming session that included all of our staff. We asked everyone about what was working and what wasn’t working.

    It was a great experience because if you are a technician, you don’t always realize the frustrations of the front desk and vice versa. This was an essential way for us to enhance the buy-in.

    AAOE: Did you experience any pushback from staff and/or physicians?

    Yes, we did receive some resistance! To counter it, though, we stressed that our purpose was simply to create a better environment for the team. Afterwards, everyone began to see that things were changing and changing for the better — especially in terms of what individuals could now able to achieve. For example, prior to going lean, staff members had repeatedly expressed interested in working four 10-hour days or maybe even three days a week. Once our offices became more efficient, we could go back to the staff and say, “Sure, we don’t need you here all the time, so, yes, you can work less days or less hours.”

    Also, before we went lean, the technicians and the front desk were the ones getting the brunt of the patients’ complaints. Now, the patient experience is much more positive overall and the complaints have dramatically subsided! That helped a lot because you really need to show your staff that you are doing this for them — and not just for the the bottom line. It’s about the overall success of the practice as a whole.

    AAOE: Did you implement lean first in small groups and then demonstrate your success to a larger audience?

    In each satellite clinic, we actually involved the entire staff at the same time. I know that a lot of lean practitioners advocate for smaller groups first; however, in our situation, the physical space is very limited, and so it would be difficult to make changes for just one physician and one group of technicians without it affecting the rest of the staff. Also, when you’re in a small practice, it might not be worth your effort to break it up too much — the entire process might be too spread out. Go ahead and jump in with both feet!

    • Continue reading: How One Practice Tripled Its Workforce Without New Hires 
      As clinical operations manager at the Duke Eye Center of Cary, N.C., Amanda Mestler, COT, had a problem: inefficient satellite clinics were causing unhappy patients, staff and physicians. But after she and colleague Heidi Campbell, COT, implemented lean management across the six locations, they maximized clinic flow, eliminated staff turnover and boosted the satisfaction of everyone involved.
    • Learn more about how the Duke Eye Center adopted lean management in the 60-minute webinar recording, “Proven Tactics for Running a Successful Small Practice.”