Lean is impossible without standardization

At the core of the Lean philosophy (it is one!), is standardization of patient flow, processes, paperwork, technology, training, staff, insurances and everything else you can imagine.  Why is this important?  If your practice cannot predict its cashflow month on month, cannot rely on its staff members, never knows the precise patient volume (“they don’t show up!”), it’s likely that processes are not standardized.  Start small but please start.  Follow the following steps:

  1. Imagine a patient that you are familiar with.  Let’s say, John Smith.
  2. Map out your entire process from John’s point of view. (this in Lean jargon is called value stream mapping and you really don’t need to read it). Hint: your process must start with John scheduling an appointment and end with getting paid completely for his service.
  3. Ask yourself at which points in the process things are likely to get stuck or delayed.
  4. Estimate time-taken at several points in the process (in minutes, hours, days or even months!).

We can’t move forward unless you have a clear visual picture of the above.  So, please take a moment to do this – it doesn’t have to be precise and accurate.

Start with a small step in the process that gives you a lot of pain.  Ask yourself, if it’s possible to standardize this element of the process?  If your answer is no, ask what might be another small step that gives you pain.  Keep it small so it’s easy to complete.  For example, patient “no shows” might give you pain.  Ask why this occurs.  Once you get an answer, ask why again.  After you get that answer, ask why one more time.  What do you see?

Imagine for a moment what this process might look like when it’s standardized.  In the above example, the process might be patient scheduling.  The benefit this gives rise to is a certain amount of predictability in the whole process.  It’s just like ordering a cap at Starbucks – there is a certain amount of predictability.  They ask me the same questions, I fumble through the same responses (quickly adding “skim please”), the green and black uniforms are familiar (hey, even the staff looks familiar), the cups are the same, I find sugar in familiar spots, the furniture is the familiar, and finally, the coffee – it tastes the same (almost).  Predictability.  It’s less important whether we prefer this kind of predictability or not at a coffee shop.  What’s important is that it’s one less thing to worry about.

No aspect of Lean is fully possible until key processes are standardized and achieve a certain predictability in performance.  The square block in the square hole and the triangular block in the triangular hole.  No confusion.

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