David K. Coombs
Lean Hospital Group
October 15, 2009

Here at the Lean Hospital Group we’re encouraged to see more Lean success stories turning up in the health care literature.  Have you ever been referred by your primary-care physician to see a specialist, only to wait weeks for that follow-up appointment?  Sure, the specialist is busy, but how can such long scheduling delays make sense?

Frequently, of course, those delays don’t make sense.  That’s what the Lean team at the University of Michigan’s MedSport clinic found out when they set to work on their patient scheduling process.  Pre-project surveys indicated that patients were terribly frustrated by the delays, whereas “providers felt that the system suited their needs and functioned quite well; they did not realize how inefficient it was.”

The Current State Value Stream Map was an eye-opener, allowing everyone to see the big picture.  Processing time for a patient appointment was a reasonable 11 to 31 minutes, but the total lead time ranged from 1 to 36 days!  Why 36 days?  And why such huge variability?

The usual culprits:  call-backs for missing information, interactions with referring and consulting physicians, searching for records – you get the picture.  Undaunted, the team set an audacious goal:  to schedule 90% of all patients in the first phone contact.  Using the standard work approach, they decided to accept only telephone inquiries with complete information, eliminating e-mail, snail mail, and faxes with their inevitable call-backs.  Analysis showed that pre-review of the incoming patient’s record prior to scheduling added value just 10% of the time, so that was eliminated in most cases.  Clinical algorithms were designed to help newly-empowered staffers to direct patients towards the appropriate specialist, on an urgent or routine basis.  Following training, the Lean process was implemented just two weeks later!

Results:  with the new system in place and stabilized, 85% of patients are now scheduled on the first phone call.  The clinic’s case mix includes certain complex cases which simply require different handling, on a “slow track”, and even these are scheduled in just several days.  Patients are delighted, as are the referring and in-house providers, all of whom have been freed up from the phone and e-mail tag that had been devouring so much of their time.

Another Lean success – and as always, it’s about eliminating the waste so providers’ time, skill and compassion can go where they belong – with the patient.

Reference:

Edward M. Wojtys, MD, et. al., “Applying Lean Techniques to Improve the Patient Scheduling Process”, Journal for Healthcare Quality, May/June 2009.