by The HLH Team
In healthcare, over-processing usually takes the form of patients being treated longer, and often more extensive, than is needed. From filling out excessively long forms to tests that aren’t needed, there are many ways we can trim our process, stay within care guidelines, and cut waste.
Unlike other industries, healthcare’s funding model sometimes pays for over-processing, which puts clinics in the awkward spot of either increasing the efficiency of the medical system overall or looking to their balance sheets. Other cases of over-processing are truly internal, and clinics must identify and confront them like any other industry.
Patient Intake:
Over-processing waste often starts at first contact, especially with new patients. When they fill out the form, how many data fields are you actually going to use? If you’re not planning to email them, for example, why ask?
Are patients filling the forms out long hand? This can cause spin-off frustrations (who moved the clipboard?), as well as potential data-entry time. Every time someone has to read or interpret handwriting, we’re opening the door for additional waste.
Why not have a tablet accessible so patients only fill out the form once and the data syncs to whatever other forms are required? Not all patients may be comfortable using that technology, but those who are can save you data entry time and potential mistakes.
What does the Patient Need?:
When a patient needs additional treatment after the first appointment, over-processing can happen a number of ways:
- Referring to a Specialist when a Primary Provider can provide the same care
- Ordering unnecessary testing, like asking for an MRI when an X-ray would yield the same answers
- Requesting surgical intervention when there’s an available and effective medical alternative
Sometimes this over-processing waste will actually add efficiency at the clinic level because it moves the patient to excessive care elsewhere. But Lean thinking emphasizes optimizing value at the broadest level, and adding waste to the system as a whole decreases value to the patient overall.
The key to nipping over-processing in clinics, as it is with other industries, is to enforce the standardized referral practices. Training and reinforcing documented referral guidelines with your medical staff will keep rules clear and help avoid over-processing causing procedures and tests.
Follow Ups:
We often ask for follow-up appointments with patients. These are often valuable tools for connecting and checking progress. Sometimes, however, they’re redundant.
If a follow-up exists to simply check in and ask one or 2 questions, consider a phone call or a virtual Skype call instead of in-person.
Unfortunately, how clinics are reimbursed and Lean thinking don’t always go hand-in-hand, and reducing follow-ups may not always be in the clinic’s financial interests. However, as far as overall value goes, we need to consider everywhere that over-processing happens.
Audit your Tasks:
Your staff perform some processes dozens of times a day. As with Motion, the priority we should give to focusing on any task for process improvement correlates with how often we do it. Math doesn’t lie.
Choose a process and map out every step taken in it. If you have a pharmacy in-house, for example, how many steps does it take from the doctor’s chicken scratched Rx, to the pills being handed over, to documenting after the fact. You might find that a dozen or more steps can be safely and substantially reduced.
by The HLH Team
Over-Processing is what happens when you do your job better than you’re going to be paid for. It can be accidental or deliberate, built into processes or spontaneous, but it’s all Waste.
It can be anywhere and is often hard to see. Here are a few of the usual suspects:
Pricing Insecurity:
No matter what business you’re in, it’s crucial to be confident of the value of your product. If you’re not, you may nurture an internal culture where you or senior staff feel obliged to do more than is required, for fear of losing the customer.
This isn’t discussed much, but it’s a pernicious business Waste. Whatever causes it (we’ll leave the psychoanalyzing to the experts), it results in lower margins due to adding value when not required, at various steps of the process.
Customers won’t tell you when you’re doing too much: they’re good with all free added values we throw at them. When you unilaterally upgrade material or add features, it’s very unlikely that you’ll see any ROI from it. It is likely, however, that you didn’t need to.
Be clear from the beginning, with the customer and with yourself, what the promised product is. Articulate it well, and don’t deviate without a signature.
Establish Governance:
A lot of Over-Processing happens when we literally don’t know when to stop. Unless you’re getting paid for perfection, don’t make it. The standard you construct needs to meet inspection and then reflect the value that the customer is paying for. If they want value added from there, they need to buy it.
Related to that, make sure to document every time a foreman, contractor, or estimator makes a “minor change” to any planning or drawing document. Minor changes tend to be forgotten about, not be billed, and add up quickly.
As part of planning every job, document who is giving the final say. In smaller firms, this will be the owner, but will often be delegated to a VP or other manager in larger companies. The person with the final say is also accountable for processes being done to paid value and not beyond. Having them answerable for that Waste will maintain motivated vigilance.
Use the Resources You Need:
The classic construction site scene that we all snicker at is 2 guys working, 3 guys watching. Over-Processing isn’t just not getting enough ROI for doing extra, it’s also devoting too many resources to a project than you need.
Deadlines, pressure from above, or just wanting it done quickly are all culprits. We put too many people and/or pieces of equipment into a site where they can’t properly function around each other. The result is Motion Waste, potential safety hazards, and lack of progress on the jobs you pulled them from. These all combine into the frustrating slurry that is Over-processing.
Signatures Matter:
What the boss asks for and what the customer asks for are sometimes totally different things. Customers (homeowners being most notorious), will sometimes ask for upgrades informally, whether that’s higher-end material or whole new features, during site visits.
Get their signature. If you don’t, you may discover the homeowner’s sudden amnesia while looking at their invoice, leaving you grappling with a he said/she said scenario and an upgrade that you’re not getting paid for.
by The HLH Team
You create a finished product out of raw materials. You’ve paid for it, and usually have a little wiggle-room to add margins based on possible differentiators.
If you add something extra to a widget that matters to your customer, they’ll pay more money. If you add something that doesn’t, they won’t. The money you waste by adding something without value is Over-Processing Waste.
In your Processes:
Let’s look at it like mixing coffee. A few twists of the stir-stick is usually enough, but we often add another ten. While five seconds wasted per cup isn’t world-ending, it’s wasted time that could be spent elsewhere.
Walk through your processes with several trusted team members; one isn’t enough. Over-Processing is often buried in personal habits (like excessive coffee stirring) and varies by person.
Polishing Cannonballs:
The good news is that if Over-Processing is built into your manufacturing, improvements aren’t difficult.
Again, get involved in the processes:
- Are you painting areas that won’t be visible or exposed to corrosion?
- Are you polishing a surface that doesn’t require it?
- Are your guidelines excessively tight, requiring wasteful levels of detail and scrutiny?
If Over-Processing exists, the customer will likely not notice or care if you change it. If it adds value, however, you’ll hear about it. Before trimming Over-Processing, sleep on proposed changes and make sure you strongly consider the customer, their needs, and your MVP (see below).
Standardize:
In the world of efficiency, there is the most efficient way, and all other ways. It’s like how one, and only one, car can win a race.
If two people are performing the same function in different ways, one is more efficient. Document the better process and train everyone to do it that way.
Keep your standardization organic, especially if just starting out. The next person may have a more efficient way, and so might the person after them. The more empowered your team feels to share their ideas, the more efficient your standardized processes will become.
MVP:
Pricing a product is one of the most delicate things you could do. There’s the best practice of using competitive products to benchmark, but to find a margin, you’ll likely add some differentiating features.
Finding the right balance between what customers are willing to pay and what you’re willing to charge is difficult, and you never know for sure if you’ve gotten it right. When we’re unsure, many of us start adding to our products to improve sales.
Try this: write down all the features of your product, no matter how small. Separate them between what your customer needs and what they would like.
The first column (Needs) is your Minimum Viable Product (MVP). It’s the essential core to your product. These features are untouchable.
The second column (Wants) are your added value features. Here’s where to get critical. Does your customer want each of these features enough to pay for them to increase your margins? Or are they frills that won’t give you visible ROI?
With each new product and feature you want to add, repeat this exercise. If the customer isn’t willing to pay, don’t add it.
by The HLH Team
“The secret of change is to focus all your energy not on fighting the old, but on building the new.”
-Socrates
We can’t ignore disruption. It impacts every single industry and if you think your business is immune, it will impact you hardest.
We can’t stop it, but we shouldn’t fear it, instead we should prepare for it. Here are the three best ways that you can prepare your company, while making more money in the process:
Think Like a Startup:
Starting a company teaches us about vigilance: we track every dollar, question every expenditure, and consider every new option for growth. But as our business grows, vigilance often falls away. We accumulate expenses with dwindling ROI, fail to motivate our employees like we used to, and fall into routine.
Technology is emerging all around us at unprecedented rates. Make it your job to be hyper-aware of it. Try to take at least a couple hours per week to read, learn, and think about how to adapt to the emerging technologies to prepare for the possible industry disruptions.
Get back to thinking about the essence of your business model. What need are you satisfying? How could you satisfy that need most efficiently? Go back to scrutinizing every dollar and think like a startup again, using those fresh ideas as new motivation.
Don’t Neglect Your Lower-Paying Customers:
It’s human nature to follow the money. Industries typically begin with a wide spectrum of customers. As time goes on, we tend to focus on the increasingly narrow segment of customers with the highest ROI, often without even realizing we’re doing so.
This leaves an increasingly growing number of customers out in the cold, who can’t afford the higher prices that successful industries gravitate towards. Those who keep paying-in start to feel taken for granted, providing the bread and butter while businesses focus on the richer jam.
Technology allows potential disruptors to reach those neglected customers quickly, pulling them away from you before you even notice.
Is your industry neglecting a large number of customers? Have you been catering your products and services to the minority? If so, you may want to strategize on how to better include your ignored “bread-and-butters”.
Stay Nimble:
If we were to read a list of established businesses that disruption managed to bury, we realize that many of them had the option to adapt, but chose not to. They were doing just fine doing with what they’d always done.
Disruption teaches us two things:
- No industry is safe, no matter the size.
- Flexibility works better than fear.
Don’t be scared of disruption, be adaptive to it. Never be satisfied doing the same thing, day in and day out. In a world as rapidly changing as ours, comfortability means you’re falling behind.
Always ask yourself: how can my business do better? How can we service all customers better? How can we improve processes for a better bottom line? How can we use technology smartly to be proactive against the inevitability of change?
by The HLH Team
Both patients and staff need to wait, and both waste money when they cross the line from normal to excessive. Internal waiting waste costs money in the usual frustrating fashion, but patient waiting waste has different financial consequences.
For clinics, patient waiting waste is akin to defect waste. They walk away with a bad feeling about their experience, which then trickles into eroding, long-term reputational damage that you may not notice until it’s a real problem.
Waiting and more Waiting:
Clinics and waiting waste are like Jekyll and Hyde: you often can’t have one without the other. Patients’ top complaints are often about waiting, whether that’s in the waiting room or waiting for test results.
Waiting is inevitable, but you can help take the edge off. On top of the usual talk shows and magazines that no one wants to touch, how about some mobile games offered on your website or social media pages to keep the kids busy? Slightly less stressed-out parents can equal a lot of savings in staff fatigue.
Test Results:
Waiting for test results can be excruciating. Many clinics have, largely due to workload, quietly adopted a “no news is good news” approach, and sometimes don’t call patients even when the results are positive.
Unfortunately, this leaves some patients waiting for excessive amounts of time for a call that may never come. The sound of good news not being passed on and bad news being forgotten about is the same: silence.
Give your patients the heads up about your policy for test results in person. Make sure you’re on the same page about how long it will take, and that they have a number to call with any questions. Patients sitting and stewing about test results are more likely to spread negative word-of-mouth about your clinic.
No Shows:
When a patient doesn’t show up to an appointment, it shifts waiting waste to the clinic employees and wastes the resources spent in booking and preparing for that patient to arrive. Personal emergencies happen, and you can’t eliminate every no-show, but today’s technology makes it easier to reduce the percentage.
If you’re not already making a phone call 1-2 days in advance, consider starting. Preferably not using an automated message, which sets an impersonal tone from the start.
Technology, and the expectations for it, are changing quickly. When you call, many are unlikely to pick up an unknown number. When it goes to voicemail, a growing percentage of people (especially younger generations), simply won’t check it.
How about automated texting to confirm appointments? If someone can’t make it, they have the opportunity to simply text a code back to cancel and you’re not left waiting. The call is important, but for those who can’t be bothered to pick up, check their message, or call back, texting is a great “when-in-rome” solution.
Predictable Timings:
Patients’ waiting gets all the press, but staff do their share, as well. Sometimes internal waiting waste is a result of staff waiting around because they’re trying to reduce patient wait times by making themselves accessible.
How long do your processes take? Administering a flu shot or removing a wart take, with a certain variation based on patient chattiness and other causes, a predictable amount of time.
Healthcare professionals juggle tasks all day. Make sure everyone is on the same page about how long a task takes so the next staff member to see them is there at the closest reasonable time.
