• How One Practice Tripled Its Workforce Without New Hires

    Written By:

    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.

    In this interview, Mestler explains how lean management can keep your staff motivated and improve your practice’s work culture. For more on her practice’s turn-around story, see the webinar recording, “Proven Tactics for Running a Successful Small Practice.“

    AAOE: What was unique about Duke’s implementation of lean?

    We weren’t just looking at one office or one clinic. Our implementation involved six subspecialty-specific satellite clinics that all functioned in different ways. One of the locations was already very successful, though, so we used that as a model to streamline our processes, standardize all of our rooms and cut out the waste.

    That’s not an easy task. Before, staff members couldn’t pop in and work in other clinics because they simply didn’t know how the different locations operated. But once we were able to cross-train our technicians, we realized we could share staffing.

    Now our staff can work in any of our clinics with much more ease. And it essentially tripled our workforce. We can now cover maternity leaves and unpaid medical leaves much more easily. And the staff really enjoys it too because now they get to work in new environments, meet new people and see new patients.

    AAOE: How has lean management helped your staff stay motivated?

    Once we empowered our techs and gave them the necessary cross-training, they quickly realized that they really knew their stuff and that they could further succeed by taking their certification to the next level. By doing so, work became more than just a job for them — it became a career. And Duke pays very well for increased certification, so that was a huge incentive for our staff. Of our 36 staff members, 17 went on to a higher level of certification after our offices went lean.

    To keep them motivated, we’ve included staff throughout every step of the lean process. For example, our triage process was a mess, and so we asked them to help revitalize it: “What are your ideas? How would you run it?” We wanted them to do the research, figure out what was going on and come back to us with fresh ideas. They needed to know that we weren’t just telling them what to do. We wanted to convey that their ideas were being heard.

    AAOE: Have you seen a major shift in the work culture as a result of all these changes?

    I really have. Now our staff isn’t hesitant to come up with new ideas because they know if something’s not working, we’re willing to tweak it or try something new.

    For example, prior to going lean, our physician templates were a bit of a mess. Template use was low, and our patient volume suffered, especially in our retina clinic. Retina is constantly evolving in terms of the need for more and more in-office treatments for, say, intravitreal injections. We started to realize that these templates needed to be tweaked constantly as well.

    The first thing we did was go to our retina-injection team and ask them, “What’s working? What’s not? Are too many injections coming in all at once, or are they all coming in too late? Are they getting too bunched up?” The staff had very helpful ideas.

    And this did promote a culture shift. Staff now realizes that their workflows aren’t set in stone. If they are having problems, we’ll tweak it until we get it right.

    “Going lean” really is a “try it” endeavor. If something doesn’t work, tweak it. If it still doesn’t work, tweak it again. And, yes, all of this change can be difficult to absorb, but lean is all about augmenting those things that will make everyone’s day in and day out easier. The end game is worth it!

    • Continue reading: Going Lean: How to Get Staff Buy-In 
      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.
    • 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.”