Make Your Clinics Flow with Synchrony

Aneesh Suneja, Dennis Han

Description

Synchrony is the ability of a healthcare process to control the pace of the physician process and the pace of the patient process such that the physician and patient are ready for each other at the same time, without waste or delay. When a process achieves synchrony, the patient does not wait for the doctor, nor does the doctor wait for the patient.
Dr. Dennis Han is an ophthalmologist specializing in diseases of the retina at the Medical College of Wisconsin and Froedtert Memorial Hospital; Aneesh Suneja is an engineer and lean consultant who worked with Dr. Han to transform his practice. With the help of Suneja, Han’s patients experienced an 85% reduction in non-value added wait times, and a corresponding 97% “top box” rating on patient satisfaction surveys (“strongly agree to recommend this doctor’s office to others”). Financially, his practice saw a 25% year-over-year increase in relative value units (RVU) production and a 41% increase in payments due to increased physician availability.
If you are a physician, clinic manager, administrator, technician, or provider of health services in a clinic setting, you can use the guidelines described in this book to effect a transformation as well.
"Thank you, doctor Dennis Han, MD, and co-author Aneesh Suneja, MBA, for this marvelous work that applies Lean principles in healthcare settings. The focus on physician medical clinics is a brave venture into this complex, hectic world that has traditionally been dominated by physicians with a predominant emphasis on patient volume, and subsequent billing volume, versus caring for their customers… This important work is essential for just about all existing physician clinics." Dale Farris Healthcare quality improvement specialist with 25 years experience.
"Lean principles have opened up more slots for patient care allowing better clinic and staff utilization, and have increased patient throughput while reducing employee overhead and burnout. There is a joy on the faces of the staff when they get to leave the office earlier than expected because lean principles have been deployed." Jose Martinez, MD Practicing physician and beneficiary of the “Synchrony”
"Physician office managers and their medical staffs would be the primary targets for this book. However, I also see it being applicable to the higher educational setting…[such as in colleges and institutions teaching healthcare improvement.]" Jim Bente Vice President, Planning and Institutional Effectiveness, College of duPage Adjunct Faculty, Carnegie Mellon University

Sujets

• Business
• Qualité, hygiène, sécurité, environnement
• Total Quality Management
• Gestion et management
• Economics

Informations

• Publié par: ASQ Quality Press
• Date de parution: 11 janvier 2016
• Nombre de lectures: 0
• EAN13: 9781953079619
• Langue: English
• Poids de l'ouvrage: 3 Mo

Extrait

Make Your Clinics Flow with Synchrony

Also available from ASQ Quality Press:

Lean Doctors: A Bold and Practical Guide to Using Lean Principles to Transform Healthcare Systems, One Doctor at a Time Aneesh Suneja and Carolyn Suneja The Lean Doctors Workbook: An Application Guide for Transforming Outpatient Clinic Systems with Lean Aneesh Suneja and Carolyn Suneja Executing Lean Improvements: A Practical Guide with RealWorld Healthcare Case Studies Dennis R. Delisle The Lean Handbook: A Guide to the Bronze Certification Body of Knowledge Anthony Manos and Chad Vincent, editors Lean Acres: A Tale of Strategic Innovation and Improvement in a Farmiliar Setting Jim Bowie Advanced Quality Auditing: An Auditor’s Review of Risk Management, Lean Improvement, and Data Analysis Lance B. Coleman The Quality Toolbox, Second Edition Nancy R. Tague Root Cause Analysis: Simplified Tools and Techniques, Second Edition Bjørn Andersen and Tom Fagerhaug The Certified Six Sigma Green Belt Handbook, Second Edition Roderick A. Munro, Govindarajan Ramu, and Daniel J. Zrymiak The Certified Manager of Quality/Organizational Excellence Handbook, Fourth Edition Russell T. Westcott, editor The ASQ Auditing Handbook, Fourth Edition J.P. Russell, editor The ASQ Quality Improvement Pocket Guide: Basic History, Concepts, Tools, and Relationships Grace L. Duffy, editor

To request a complimentary catalog of ASQ Quality Press publications, call 8002481946, or visit our website at www.asq.org/qualitypress.

Make Your Clinics Flow with Synchrony

A Practical and Innovative Guide for Physicians, Managers, and Staff

Dennis P. Han, MD Aneesh Suneja, MBA

ASQ Quality Press Milwaukee, Wisconsin

American Society for Quality, Quality Press, Milwaukee 53203 © 2016 by ASQ All rights reserved. Published 2015 Printed in the United States of America 21 20 19 18 17 16 15 5 4 3 2 1

Library of Congress CataloginginPublication Data

Names: Han, Dennis, author. | Suneja, Aneesh, 1968– author. Title: Make your clinics flow with synchrony : a practical and innovative  guide for physicians, managers, and staff / Dennis Han, MD, Aneesh Suneja,  MBA. Description: Milwaukee, Wisconsin : ASQ Quality Press, 2016. | Includes index. Identifiers: LCCN 2015043405 | ISBN 9780873899239 (hard cover : alk. paper) Subjects: LCSH: Medical offices—Planning—Handbooks, manuals, etc. |  Physician and patient. Classification: LCC R728 .H353 2016 | DDC 610.68—dc23 LC record available at http://lccn.loc.gov/2015043405

ISBN 9780873899239

No part of this book may be reproduced in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the publisher.

Publisher: Lynelle Korte Acquisitions Editor: Matt T. Meinholz Managing Editor: Paul Daniel O’Mara Production Administrator: Randall Benson

ASQ Mission: The American Society for Quality advances individual, organizational, and community excellence worldwide through learning, quality improvement, and knowledge exchange.

Attention Bookstores, Wholesalers, Schools, and Corporations: ASQ Quality Press books, video, audio, and software are available at quantity discounts with bulk purchases for business, educational, or instructional use. For information, please contact ASQ Quality Press at 8002481946, or write to ASQ Quality Press, P.O. Box 3005, Milwaukee, WI 532013005.

To place orders or to request ASQ membership information, call 8002481946. Visit our website at http://www.asq.org/qualitypress.

 Printed on acidfree paper

We dedicate this book to our wives Mary Lynn Han and Cary Suneja.

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Table of Contents

List of Figures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Introduction: Definition of Synchrony . . . . . . . . . . . . . . . . . . . . . Chapter 1 Observe the Patient Process. . . . . . . . . . . . . . . . . . . . Patient Observations and Data Collection . . . . . . . . . . . . . . . . . Waste. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Workload Distribution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Chapter 2 Visually Manage the Patient Process at the Front Line . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Passive Systems for Patient Flow . . . . . . . . . . . . . . . . . . . . . . . . Problems with a Passive System . . . . . . . . . . . . . . . . . . . . . . . . . The Patient Status Board . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . CrossTraining for a Multifunctional Team . . . . . . . . . . . . . . . . Dependent and Parallel Steps . . . . . . . . . . . . . . . . . . . . . . . . . . . Chapter 3 Adjust and Control the Gears for Synchrony . . . . . Changeover . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Pods. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Workplace Organization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Chapter 4 Plan for Variation in Patient Type and Length of Visit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Chapter 5 The Environment for Synchrony. . . . . . . . . . . . . . . . Metrics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Physical Layout and Space Utilization . . . . . . . . . . . . . . . . . . . . Flexible, MultiPurpose Treatment Rooms . . . . . . . . . . . . . . . . .

vii

ix xi xv xvii 1 3 5 6

11 12 15 16 18 19 23 25 26 27

29 37 38 40 42

viii Table of Contents

Central Location for Shared Resources . . . . . . . . . . . . . . . . . . . Shared Workrooms That Colocate Physicians and Staff . . . . . . Chapter 6 Techniques for Change Agents . . . . . . . . . . . . . . . . . At the Beginning of the Transformation. . . . . . . . . . . . . . . . . . . Questions to Keep in Mind. . . . . . . . . . . . . . . . . . . . . . . . . . . . . In the Middle of Your Transformation . . . . . . . . . . . . . . . . . . . . Team Leaders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . When Change Is Undermined . . . . . . . . . . . . . . . . . . . . . . . . . . Another Special Issue: EHR. . . . . . . . . . . . . . . . . . . . . . . . . . . . Questions to Keep in Mind. . . . . . . . . . . . . . . . . . . . . . . . . . . . . Chapter 7 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Epilogue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Index. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

43 46 51 52 55 56 57 59 60 60 63 65 67

Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9 Figure 10

Figure 11 Figure 12 Figure 13

Figure 14 Figure 15

Figure 16

Figure 17

List

of

Figures

Synchrony diagram—target state. . . . . . . . . . . . . . . . . . . . . . The A3 problemsolving form. . . . . . . . . . . . . . . . . . . . . . . . . A simple process map for data collection. . . . . . . . . . . . . . . . Percent load chart prior to intervention. . . . . . . . . . . . . . . . . . Percent load chart after initial intervention. . . . . . . . . . . . . . Silo effect from processes performed in series. . . . . . . . . . . . Patient status board. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Dependent versus parallel steps. . . . . . . . . . . . . . . . . . . . . . . Reducing dependency to reduce variation effects. . . . . . . . . Patient movement in Dr. Han’s injection clinic prior to lean changes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Multifunctional team/singleuse rooms. . . . . . . . . . . . . . . . . Multifunctional team with flexible treatment rooms. . . . . . . Technician movement before relocation of OCT equipment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Technician movement after relocation of OCT equipment. . . Common work area in the hubandspokes model in an ophthalmology clinic. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Floor plan of exam room in an ophthalmology clinic using the hubandspokes model. . . . . . . . . . . . . . . . . . . . . . . . . . . . The implementation stepladder for Dr. Han’s clinic. . . . . . . .

ix

xviii xxiii 4 8 10 15 17 20 34

41 42 43

44 45

48

48 53