Eliminating Waste in Your Practice

By Tom Ludwig, RN, MBA, FACMPE               

Have you or your staff ever wondered, “Why do we do things this way?”  You have methods or processes that are fraught with inefficiencies, and they often leave you scratching your head in confusion and frustration.

There are several reasons why this happens.  For one, many medical practices use the “see one, do one, teach one” method for training staff.  Personal preferences and work-arounds are allowed to creep into your procedures and processes, especially if the training content isn’t documented and routinely reviewed.  Another common reason is that training is often done in “silos” – that is, the training is done within the strict confines of a specific job and individual, and not in the context of how an individual’s actions might affect people in other positions.  In the end, these mutations manifest themselves in the form of additional steps and wasted time in your employees’ daily work.

How can this be fixed?  Follow these five simple steps, and you can eliminate a good share of the accumulated waste from your practice:

  1. Form a multidisciplinary team
  2. Diagram the process
  3. Identify waste
  4. Eliminate the waste
  5. Document the findings

Form a multidisciplinary team

A multidisciplinary team is the core of what makes this problem-solving method work.  Most teams will consist of a provider, a staff nurse and/or medical assistant, and a receptionist and/or scheduler.  Depending on the work process you are analyzing, other members might include lab, radiology, or business office staff.  Every type of position that touches the work process should be represented on the team.  The real value of this type of team is that everyone gets to see how their actions affects – and is affected by – the work process.  Be sure to establish team rules that allow the members to speak freely and equally.  As the manager, you might need to facilitate the work of the team.  If you do, be sure you only facilitate it – not direct it.  The product of the team must be due to the efforts of the team members, or you might find it difficult to recruit new members for future teams.

Diagram the process

Use flow charting to diagram the process as it currently exists.  (For easy-to-follow instructions on how to flow chart, please go to http://www.mindtools.com and enter “flow chart” in the SEARCH field.)  It is important that all team members contribute.  Be sure to include every step of the process so everyone understands how the process works from start to finish.  If the flow chart ends up being too long or detailed for the team to reasonably handle, then break the process into segments and work on one segment at a time.

Identify waste

Once the process is completely diagrammed, then the team should identify the steps that are unnecessary or wasteful.  A good question to ask is, “Does this step add value to the process?”  Have the team actually circle the steps that fit this.

Eliminate the waste

While it might be desirable to eliminate all the waste in a process, it might not be attainable.  However, your team should have a goal of eliminating at least half of all the “waste” steps in the process.  Sometimes the “waste” might be a step that can be eliminated.  Other times it might be a step that requires more staff training to perform it as it is intended.  Be careful, though, that in the process of eliminating waste you do not end up creating more!

Document the findings

Documenting the work of the team serves several purposes.  First, it shows the “how” and “why” of what was done.  Second, it serves as a reference for future work.  It sometimes takes several attempts at a specific work process to eliminate the desired amount of waste.  Last of all, the reworked flow chart (minus the eliminated waste) can serve as a training tool for all staff involved in the process.

The first few times you try this, it might not go as smoothly as desired.  Remember – practice makes perfect.  The more you do it the better you will get at it and the more successful the outcome will be.



Tom Ludwig is President and CEO of Forward Healthcare Solutions, LLC, a consulting firm that specializes in working with physician practices.  His 20 + years of experience as an administrator have been in roles from front-line manager to program director to Chief Operating Officer.  Tom has extensive experience in clinic operations management with expertise in strategic and business planning, process improvement and workflow efficiency, advanced access, supervisory training and leadership development.   To contact Tom: tludwig@forwardhealthcaresolutions.com or www.forwardhealthcaresolutions.com.  For more articles like this, plus your free report, “Patient Collections: It’s Make or Break for Many Practices”, visit www.efficiencyinpractice.com  and register for our complimentary enewsletter subscription.

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