More recently, I’ve developed the habit of Salvation Armying anything that I haven’t worn in a year. Unless of course, I’m overly attached to something like that blue t-shirt that’s gone with me from Lesotho to Himalayas. The cleanup helps. It keeps my wardrobe manageable and my clothes current. For some reason, this activity also keeps my mind free and allows me to think clearly. The same principle (whatever that is) applies to a medical practice. Before jumping onto the Lean train, let’s first throw out what’s not required.
I play a game every time I visit a medical practice for the first time. I observe the front desk, patients, staff, medical assistants, signs, paperwork, medical charts – anything that catches my eye for a full 5 minutes. Then I make a random judgment on how lean or fat the practice is. It’s funny – 9 times on 10, I’m right. Practices that desperately need help, leave those traces all around. Patients wait longer than normal, look more agitated than they must, there’s an undercurrent of lets-get-done-with-you, pharma reps get more love than patients do, there are little piles of paper here and there, several redundant notices, staff is always busy on the phone and everyone is searching for something…oh you’ll get enough clues. Underlying all this, you get the sense that the practice has more than what it needs.
Let’s go to your practice and do some cleanup. All you have to do is answer the following questions:
- What information is collected from our sample patient John Smith at the front desk that is not required or has been provided before or could’ve been provided before?
- What information does staff look for? Where is this information located? (psst careful readers, I’m not hinting an EMR here. I’ve seen practices manage information beautifully even without an EMR).
- How far are the fax machine, scanner, photocopier from where they are needed? Why are they printing so much? (Have you ever wondered why a front desk scans the patient’s insurance card, then photocopies it twice, attaching one to the medical chart and saving one for some other reason?)
- Is the inside wall of the front desk looking like a post-it notes hall of fame? (how do they ever find the info they need quickly?)
- Is any staff member doing two patient activities at the same time? (e.g. puts the patient on phone on hold, talks to the patient at the window, asks her to wait and reverts back to the one on phone)
Read your answers above (have you written them?) and finally list 5 things that you can unclutter immediately with no negative impact to your workflow. C’mon, you know these. Here’s one idea (“Folders”) to help you get started:
- Make two columns: clinical and practice management (PM).
- Under each column list down all the types of information that people seek from time to time. For e.g. under the PM column you might list Patient Eligibility, Insurances, Denials, Accounts Receivables.
Using the information above, create a common folder on your computer network (anyone with basic IT skills should be able to help). A sample folder is provided below. There’s no one right way – do what’s right for your practice situation with the objective of finding any information that’s needed within 5 minutes or less.
The whole idea is to access information quickly. Say, your front desk person Jane left abruptly and you requested your part-time staff Sarah to come on board full time. Without too much help from anyone, Sarah will be able to figure out on her own to get all types of basic information. For example, Sarah is trying to check if a particular Cigna plan requires prior authorization for the colonoscopy that you are about to do. She doesn’t need to search too hard to get the Cigna information she needs; it’s in the Cigna folder under Insurances.
Are you thinking, I’m a physician am not supposed to be doing this stuff and let me forward this to my office manager? It’s a good idea to remind yourself that you are a business owner too. Also that you would like to build a Lean practice that will give you the freedom to get back to patients without worrying about practice stuff. If you are an office manager or a practice administrator, this should be easy.
What else might you unclutter? Revisit your list.