• Going Lean: How You Can Improve Productivity and Patient Care


    "With a mandate to improve quality and reduce costs, every ophthalmology practice needs a strategy to accomplish these goals. I highly encourage ophthalmologists to attend the AAOE’s instruction course on lean management with one or more administrators from your practices where you will learn how to get started. We attended such a course a number of years ago with a profound impact on our practice — similar to that described by Sandy Dilts." — Robert E. Wiggins Jr., MD, MHA; managing partner, Asheville Eye Associates 

    In January 2010, I was promoted to executive director of a newly acquired eye practice whose mismanagement had accrued a $22 million deficit. Initial estimates predicted I would need five years to fix practice's finances. Instead, with the help of lean thinking, we became cash positive within my first year as executive director.

    What Is ‘Lean Thinking’?

    Like many ophthalmology clinics, ours had a very high patient volume and was tasked with doing more with less. The only thing I knew for sure when I started my new role was that we could not continue with the current processes that were in place.

    So, one of the very first things I did to equip myself for my new role was to join the American Academy of Ophthalmic Executives. The second was to enroll in lean management — a program that emphasizes a collaborative team effort to improve performance by removing waste from your company’s processes and identifying those activities that are “non-valued added.” Long used in the manufacturing industry, this concept of waste elimination focuses on the acronym DOWNTIME:

    • Defects
    • Overproduction
    • Waiting
    • Nonused talent
    • Transportation
    • Invention
    • Motion
    • Extra processing

    When applied to health care management, “lean thinking” can enhance productivity and transform your bottom line without a risk to patient safety by:

    1. Reducing length of patient stay. You can prevent errors that typically delay when your patients go home.
    2. Reducing unnecessary testing. You can prevent the waste associated with inappropriate lab testing and diagnostic imaging — all without shortchanging your patients’ needs.
    3. Reducing overtime. You can improve your practice without alienating staff with multiple layoffs.
    4. Improving your supply chain. You can reduce the amount of space used and the amount of cash tied-up in inventory by streamlining your restocking process.
    5. Delaying expansion. You can make better use of existing resources to avoid increasing capital spending. 
    6. Reducing delays and errors in billing. You can get bills out quicker and more accurately by creating a leaner billing flow.

    ‘Lean’ in Action

    After completing the lean management program, I applied the concepts to our company by developing a best practice team (my “A” team). The group was tasked with reducing the cost of office-supply inventory, streamlining patient flow and decreasing wait time.

    Getting the buy-in from my entire group was imperative to the development and success of my best practice team. Once we started implementing ideas, the organization as a whole saw the “lean” process in action, and staff and physicians began offering their own ideas in areas that I, as executive director, would not have had direct exposure to. With the adoption of this program, everyone suddenly had a different way of looking at our operations!

    Learn More at AAO 2015

    “Lean thinking” has proved one of the best organizational methodologies I’ve come across. It’s evergreen in its approach and usage, and I've seen instant and positive outcomes.

    To learn how to apply these concepts to your own practice, I highly recommend checking out the special AAOE lean-management course at AAO 2015, “The Power of ‘Lean Thinking:’ Improving Practice Efficiency, Profitability and Quality of Care” (course # SPE21). It takes place Saturday, Nov. 14, from 12:30 to 4:30 p.m. at the Sands Expo/Venetian.

    By attending, you, too, will learn the necessary tools to decrease costs, improve quality of care, reduce wait times, increase patient satisfaction and more.

    Both physicians and administrators can attend. In fact, those from the same practice are encouraged to attend together, as this will help you more smoothly implement ideas upon return to the office.

    For more information, including registration and ticket fees, use the course number above and search the Academy’s online program.

    About the Author: Sandy Dilts, MHA, COA is the executive director of the American Health Network eye specialists. She oversees a multi-specialty practice in three different locations in Indiana. The practice supports four MDs and two Medical ODs and has been recognized with the APEX Quality Award 2011-2012. Winners represent healthcare providers that consistently achieve the highest level of patient satisfaction for a given year. Also, recognized as Muncie Areas Finest Ophthalmologist 2015 Reader’s Choice Poll. Sandy has been in the ophthalmic industry for 25 years and holds a Master’s Degree in Healthcare Administration.