Happy new year to everyone and welcome to 2019! This time of year sparks both personal and professional resolutions of all forms and this year started similarly for me. I have been receiving requests from fellow OD practitioners who want to make changes in their practices to improve profitability, while also improving patient retention and quality of care. What a perfect time and subject matter to discuss clinical operations efficiencies and how the principles of lean processing can improve your practice!
Lean processing was first introduced by the automotive manufacturing industry as Kiichiro Toyoda and Taichi Ohno of Toyota improved upon Henry Ford’s assembly line process in the 1930s.1,2 The process started to become more popular after the book, "The Machine that Changed the World," by James P. Womack, Daniel Roos, and Daniel T. Jones, which was published in 1990 and, "Lean Thinking" in 1996 by James P. Womack and Daniel T. Jones.2 In healthcare, lean processing maximizes the value for patients by eliminating waste in every step of the process, which ultimately has a dramatic increase in productivity, costs and quality.
With any operational change, you must start identifying the problem, or more positively stated, opportunities of improvement. This is an important step and not always the easiest to identify because practice owners have tremendous emotional attachment to what they built. Figuring where opportunities bring the most value can be extremely biased, but if practice owners can step away from being the problem-solver to problem-framer, the lean process can begin. Remember, value is not defined by you or your staff; value is ALWAYS defined by your patients.3 Framing the opportunity should be simple and clear to promote a path from your actual condition to the desired condition. If it is too broad, value may not be able to be reasonably measured or observed. For example, "We have too many no-shows," is extremely broad. You should consider reducing the scope and get more specific by framing the opportunity as, "Our no-show rate is 50% on Mondays and Saturdays and 30% on Thursdays and Fridays."
Now that the problem has been specifically defined, you can start implementing lean processing into your practice. Lean is a continuous improvement process. It is not something you perform once a year but is embedded in your practice’s culture. Your entire staff, including managers, technicians, opticians, and front desk staff, should be empowered to create a patient-centered process for continuous improvement. The process and steps are fairly intuitive, but sometimes can be complex and challenging to achieve.
The five steps of lean processing are: identify value, map the value stream, create flow, establish pull, and seek perfection.4 Expanding from the previous example of improving the no-show rate of the practice, identifying value from your patients’ perspective requires a period of discovery that might consist of surveys, focus groups, or other techniques that produce qualitative and quantitative data. That data is now the starting reference point to map the value stream and eliminate all the waste from each step of the process, creating a better flow.
Establishing the pull comes from efficiently managing inventory, also known as Just-In-Time (JIT) inventory. JIT inventory eliminates waste in terms of cost of capital in manufacturing systems by reducing inventory to a minimal level, ensuring components used to create finished goods are delivered to the production area exactly on time.5 In healthcare, pull is simply responding to patient demands as quickly as possible without creating excess steps.
Lastly is the step of seeking perfection. This is where changing your culture starts. Perfection truly cannot be achieved but should always be pursued. You and your staff need to respond relentlessly to changes in patients’ values. Team building and meetings should always focus on the elements that bring value to the patients, eliminating more waste, and other opportunities to continue improvements in speed and quality while reducing waste.
Overall, starting to implement lean processing can seem intimidating and requires an objective perspective to maximize the results. The advice and experience of a third party can be extremely helpful in identifying opportunities in your practice to reduce waste and create value for your patients.
Bryan M. Rogoff, OD, MBA, CPHM has a unique background in areas of holistic eye care, business management and healthcare reform. He specializes in LEAN clinical management and operations, technology implementation, healthcare strategy, and strategic partnerships. Currently, he serves as a consultant for for the FDA, Immediate Past-President & Education Chairperson for the Maryland Optometric Association, Federal Keyperson and Meetings Committee Member for the American Optometric Association, reviewer for the Council on Optometric Practitioner Education and is the Founder of Eye-Exec Consulting, LLC. To contact Bryan, visit www.eye-exec.com or email firstname.lastname@example.org. He can also be found on LinkedIn, Facebook, Twitter and Instagram.