Lean Lets Practice Focus on Patient Experience

Why would a private practice like Atrium Obstetrics and Gynecology decide to embrace Lean, the methodology used to efficiently produce high-quality products, usually associated with manufacturing?

“So patients can have a stress-free visit and our staff can be more organized and more efficient,” says Practice Manager Ruth White. After applying Lean, the practice has adopted a new floor plan and improved processes, resulting in
better care for patients, including decreased wait times and more face-to-face time with providers.

Lean Tools in Action

Dr. Gary Haakenson, an Atrium physician, had heard that nearby Rex Hospital used Lean to reduce patient wait and discharge times in its emergency department, with assistance from NC State University Industry Expansion Solutions. He wondered if the same principles could help a private practice like Atrium ObGyn, and the practice decided to find out. In November 2009,
physicians and staff spent a day with IES Lean improvement specialists in a classroom on Centennial Campus, splitting shifts so that they could continue to see patients in the office.

Over the course of the day, Atrium employees learned how to challenge processes to determine whether each step of the process adds value. IES Improvement Specialists Bill Iacovelli and Anna Poteat Godwin led the group in an exercise based on the experience of a patient filling a prescription at a pharmacy. The staff quickly saw how the lessons learned in the exercise could improve their daily operations.

“I saw light bulbs go off as they went through the exercise,” says White. Later, a smaller group spent an additional three days with Iacovelli learning how value stream mapping breaks down each process into steps so that redundancies and unnecessary actions became apparent, and could be eliminated. Atrium staff and physicians were able to spot trouble areas—patient flow and staff efficiency—where they could realize improvement.

“Now we’re always thinking about what we can do better to improve the patient experience in our office,” says Atrium physician Dr. Matthew Alvarez.

Read All About It

The value stream mapping session generated a Lean Event Newspaper, which White keeps taped to her office door. There, anyone can see who is responsible for each project and how it is proceeding.
Some projects were implemented immediately, including:
• Patient forms reduced from 5 to 3 pages
• Cups for urine samples moved from the reception area to a
discreet restroom location
• Codes for lab requisitions posted, so staff aren’t
rummaging through file cabinets in search of them
• Out-of-date insurance cards systematically removed from
patient files
• A model exam room created and its shelves and storage labeled,
with the goal of creating standardized exam rooms
across the office

In the practice’s new office, Lean led to further positive changes:
• Lab moved from the back to the front of the office, since many
patients come only for lab work
• A new lighting system in the exam rooms signals when a
patient is ready for vitals, and to see the physician
• Additional restrooms added so that patients aren’t standing in
line to obtain specimens
• More exam rooms per provider added so that provider isn’t
waiting for a patient to be brought back
• History room added, so that obstetrical history can be
obtained by the nurse in a comfortable environment
• Second vital signs area added, enabling staff to move patients
more quickly to exam rooms
• Three spa-like waiting areas created; after vitals are taken
but before exam rooms are ready, patients are able to relax
while listening to soft music or the sound of tinkling water
in fountains
• Improved signage, to allow patients to escort themselves to
the lab and exit
• A rolling cart utilized to replenish supplied in exam rooms,
decreasing the number of staff visits to the supply closet
• Hampers added to each exam room, removing them from
publicly visible areas
• More storage created, to assist staff in locating archived records

“It’s actually simple,” White says of the lengthy list of improvements. “The challenge is taking the time to analyze current processes from a patient’s perspective. Plus, we had the added benefit of planning our new space for efficiency and better patient satisfaction.”

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