A Better Mousetrap…

Within my current role, I work with Health Systems, hospitals, and practices to improve patient care of their chronic patient population, increase organizational efficiency, develop and standardize clinical workflows, and several other areas.  The model for this project does not follow a typical flow or process and my role lends itself to being more of an organizational efficiency consultant mixed with project management tasks heavily related to scheduling, client management, and helping lead organizational change.  

I often find myself answering to the same objections; the processes in place already work well and I don’t want to change.  Does this sound familiar?  Leading change is difficult enough when you have support both from leadership and the rest of the project team, but when shackled with conscious objections from those involved with the change effort it can become a daunting task.  What would you do to handle this challenge?  What method would you use?  Thus far a statistical showcase has proven quite helpful.  

Within any health system or practice the main payment method or arrangement is a fee-for-service model.  Increasing revenue then becomes merely an act of efficiently utilizing the same resources, in the same allotted time to render more services thus increasing revenues.  I can think of numerous places to start but one area I chose to start with was analyzing cycle times.  In other words, from the time to patient walks through the front door, to the time they leave, how long did it take.  Choosing what to measure was the easy part, deciphering how to, and getting the staff to measure it correctly became the challenge.  

Within any process or cycle time, regardless of the in/out time, there are interior process or sub processes that make-up the overall process.  Each one of these is much like any other project plan you may develop over the years in that they all have a predecessor or successor activity, have lead and lag times, and a critical path of completion can be derived.  Knowing this, I asked the staff to monitor cycle time for patients.  Specifically I asked them to once the patient walks through the door, follow them recording exactly when they did something, and who performed the process.  I asked them to record wait times, durations of processes, specify if acute, chronic visit, and any other appointment type, appointment length, appointment time-of-day, and appointment day-of-week.  Essentially I wanted a statistical account of their entire visit so that data could then be charted and aggregated to look for trends.  

Components I was specifically looking for were bottlenecks or snags in the process flow.  One of the most important components to finding a bottleneck was the comparison of active process and wait times within a given function.  For example, if the actual time to draw labs upon entering the lab was 3 minutes, but the wait time was 12 minutes, then I can quickly deduce that there is a disproportionate amount of wait time in the lab.  Hopefully that helps illustrate the need for the detail I had asked for.  

Now once the data was recorded and aggregated and I could look for trending, and as data continued to stream in, I could then look at run charts to see trending based upon time.  Did I then have enough to determine both bottlenecks and causes?  I was able to uncover the bottlenecks; however I was only able to uncover the causes of a couple bottlenecks.  Even though I could statistically show disproportionate wait times, I was unable to show root cause of the issue.  This is exactly what I wanted to have happen.  

Imagine you had built a mousetrap.  It trapped mice, was easy to clean up, your customers were happy with the product, and you made a decent profit off the sale of them.  Do you have motivation to change?  That depends on several factors but would speculate that if the profit margin provided a return you were comfortable with it might deter you from spending the time, money, and effort trying to change.  

This is the objection I had received from most of the practices I asked to obtain these measures.  As I mentioned earlier all I wanted was the data and to be able to show bottlenecks.  Essentially I was able to extract inefficiencies and show exactly how much revenue they were missing simply from inefficient clinical workflows.  How?  Consider the data I obtained.

I had a measure of how long it took to perform every task, on average, across each person who performed that task for any given appointment type, time-of-day, and day-of-week.  I could then aggregate that data and extrapolate what an average cycle time in/out would be for an acute, chronic, wellness, physical, etc.  I then was able to extract the average wait or idle time and again pull together and aggregate the information to show averages for each type of appointment or patient.  Once the two different measures were calculated, finding the lost revenue amount was fairly easy. 

Once I had accomplished this, I created an environment that became focused on improving organizational efficiency and defining better clinical workflows.  Remember that even though something may be working, doesn’t necessarily mean you can’t help an organization build a better mousetrap.  

Chris Thompson PMP, SSYB