What Daily Process Improvement Looks Like in Professional Services

What Daily Process Improvement Looks Like in Professional Services

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Process Improvement is at its best when it doesn’t look like much. We often fall into the trap of needing expensive equipment or consultants to save money and, in the end, it costs us money.

Rule of thumb: real change needs to develop from inside. If you try to force it from the outside, it will be short-lived – and expensive.

In Professional Services, improving efficiency usually means increasing turn around times (whether that’s a file for a lawyer or a patient for a clinic) without sacrificing attention to detail. Spoiler alert: if it feels easy to start, you’re doing it wrong.

Changes that make real money have 3 overlapping qualities: they’re about leadership (it starts with you, not them), problem-solving (as in, they must address the root source of inefficiencies that already exist within the organization), and culture (the buy-in required, which leads to consistency).

 

Case in Point

Let’s imagine a busy dental clinic as our case study. The waiting room is chaotic, patients are waiting long periods for their appointments to start, and dental hygienists are feeling rushed as frantic receptionists react to impatient clients. The practice owner hears complaints from staff that they’re under enormous stress.

The first thing the owner does is hire a consultant. The consultant hears the words “busy”, “chaotic”, and “disorganized” from the practice owner, and walks into the clinic. He assesses that the software the receptionists are using is outdated and recommends a more powerful software tool. The software is exorbitantly expensive, but the consultant assures the practice owner that it will answer all their problems.

But does it? Not necessarily. The receptionists struggle to re-learn their jobs as they adjust to the new software. Patients continue to wait, as the receptionists struggle to navigate the program. Dental hygienists are still rushing, as the extended check-in time cuts into their appointment blocks. Staff are more distressed than ever. How could this investment be putting the clinic further in the hole, and not further ahead?

The practice owner started from the wrong place. Consider the qualities of effective process improvement for your team, and how they could have changed the outcome at the clinic:

 

Leadership

You have a well-educated, professional team who trained for years to get into your office and make it work. You don’t need to make process improvement an edict. They want to help, just let them.

Catch 10 people at their desks (when they aren’t fighting deadlines) and ask them what bugs them.  They probably have answers to that question and have been waiting to be asked. Have those conversations that we always think we don’t have time for.

Authentically support your team and they’ll embrace process improvements.  That brings in the next hurdle; that change will evaporate in 4 months if you put the autopilot on.

Systemic change is a commitment. It’s:

4 steps to professional leadership

Good leadership is about fostering a healthy sense of urgency. Unhealthy urgency is unsustainable and corner-office-driven. You need urgency from lunchrooms, cubicles, and front desks.

 

Problem-Solving

The problems of one department are often connected to the problems of another. Sometimes, those issues originate from a lack of clarity from the top. Get to the bottom of the barriers holding your team back by:

  • Mapping out the challenges across the organization: As leaders, we can never look at our teams’ issues in a vacuum. It can be helpful to create a visual ‘org chart’ and list the struggles under each department. Then, we can take a step back and truly see where issues originate and how they intersect.
  • Finding out what’s getting in the way, and changing it: Your team can’t do the job without the right tools. Whether breaking down departmental silos, training for more skills, or reorganizing your management structure, you need to make it happen for your strategic culture to take root.
  • Document, document, document! It’s great to experience that “aha!” moment in a staff meeting and verbally agree to a new process. But time goes on, people leave, and new people replace them. Processes that aren’t documented – and accessible! – are the dormant problems of the future.

 

Culture

“Empowerment” is a great word to include in a PowerPoint, but we need more than lip service. We need follow-through. You can create cultural shifts 3 ways:

Let’s visit our dental office in a parallel universe. In this universe, the practice owner started by speaking to staff and explaining his vision of a calm, efficient clinic. He listened to their problems, asked questions, and took notes. He stepped back and realized that the triage process for new patients was being done verbally, tying up staff unnecessarily. The receptionists documented their triage process, which became a form for patients to fill out upon arrival. By encouraging all of this, he also set a precedent for everyone to think differently about their impact within the workplace.

 

In its most effective form, process improvement is the path of least resistance, even if it has a few overgrown weeds in the way. It’s up to us to clear the lines of communication and help our teams move forward.

 

“For companies to change, we need to stop thinking like mechanics and to start acting like gardeners.”

 

— Alan M. Webber

4 Ways to Create a Culture of Process Improvement in Professional Services

4 Ways to Create a Culture of Process Improvement in Professional Services

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culture process improvement professional servicesIntroducing process improvement into the culture of your organization will remove waste and bring value. We know it. You know it. And we’ve both seen the improved product quality, happier employees, and optimized resources that process improvement brings.

But if we want these improvements to stick over the long-term, we need a transformational change in the way people look at their work.

So, how can this transformation happen?

The companies who have succeeded swear that it is a multi-year process that will do well only with long-term vision and commitment.

Dr. Andrabi, the former president of Mercy St. Vincent Medical Centre in Toledo, Ohio, spotted the inefficiencies in how patient transfer was being handled and saw an opportunity to jump-start transformational change. They began by bringing various staff members together to map out the existing process. Then they discussed where the group wanted to go and brainstormed how to cut inefficiencies at each point in order to get there. Next, they tried out their ideas, evaluating the results along the way. Once the best plan was chosen, it was implemented in the long term.

Today, St. Vincent has a single hub that receives transfer patients and assigns them a bed in 10 minutes. Previously, the process took at least an hour. The hospital runs so efficiently that they witnessed a 26% increase in transfers.

Here are four ways to incorporate process improvement in your company’s culture to usher in transformational change.

 

1. Kanban Board

A Kanban Board is a workflow optimization tool that helps you monitor and improvise the flow of a project.

Kanban Boards can map your team’s workflow by showing you the various stages of progress. At its basic level, a Kanban board is divided into three phases: Requested, In Progress and Done. The board will help you identify how the requested work is progressing and where work is stuck. If managers find the work getting delayed continuously, then they can investigate and find the root cause and solve it.

The beauty of this concept is that it allows you to divide work and allocate it to people within a team. Though responsibilities rest on different shoulders, the workflow remains coordinated.

Sound Immigration, a Washington based immigration firm, started using a Kanban board, and they identified that the response time from clients was the main reason for delays in case processing. By making changes, they benefited in the form of organized workflow, improved collaboration and preventing wasteful processes.


kanban board by bossarro

Team Kanban Board for Product Development by Bossarro

2. Continuous Improvement Meeting

Meetings are an ideal venue to analyse the workflow and identify specific waste elements with your team. But we’ve all seen how too many meetings suck our time and can become the ‘waste’ we are trying to eliminate.

A quick way to prevent this, but continue to monitor workflow, is to conduct simple, daily stand-up meetings. As the name suggests, they are conducted while standing, and every team member must answer three questions:

  •    What did I accomplish yesterday?
  •    What will I do today?
  •    What obstacles are preventing my progress?

This simple and quick meeting will encourage information sharing between team members and encourage collaboration. The fact that you are standing will prevent the meeting from going off course and dragging on for too long.

Read our own experience with Stand-Up Meetings here.

 

3. Shared Leadership

Contrary to what you may think, shared leadership doesn’t mean letting the team loose. It’s about creating an environment of trust and encouraging accountability.

When you invite team members to become project leaders, you:

  •    Break down the hierarchy that prevents independent decision-making
  •    Boost motivation
  •    Cut back on the bottlenecking caused when one or two people have the sole authority to make decisions
  •    Free up your frontline staff from focusing on tiny project details

After implementing this concept, LAANE (Los Angeles Alliance for A New Economy) discovered an increase in mutual respect and trust among staff and accountability among leaders. The projects became transparent, and each staff member became aware of who is involved in decision making. LAANE’s end goal was to develop shared metrics of success for individuals and teams and interconnect various departments and programs. Besides achieving this target, the change encouraged staff to ask questions, voice concerns, and offer suggestions using open dialogue.

culture process improvement professional services

4. Synchronous and Asynchronous Communication Training

Good communication is essential to process improvement. Period.

The problem is that most people communicate poorly. They pick the avenues that are most convenient or comfortable for them without considering the people on the receiving end. And, if you have a team that doesn’t interact or collaborate well, it has a direct impact on the outcomes your company achieves.

To help your people get on the same page, start by teaching them two communication models:

  1. Synchronous communication – communication that needs immediate attention and should be conducted face-to-face, through telephone or videoconference.
  2. Asynchronous communication – communication that can be delayed, and can be submitted by email or chat platforms.

Half the battle in getting communication right is choosing the right channel. By helping your people choose well, you’ll eliminate the mixed messaging and delays creating unnecessary friction in your workplace.

Creating a culture of process improvement in your organization is a long-term strategy. Investing now in workflow optimization, consistent facetime with employees, leadership experiences, and communication training will pay dividends as it builds problem-solving into every aspect of your organization.

“Progress is impossible without change; and those who cannot change their minds cannot change anything.”

— George Bernard Shaw

The Winding Path Toward Culture Change CTA

How to Reduce Deadly Waste in Professional Services: Motion

How to Reduce Deadly Waste in Professional Services: Motion

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Nurse wearing rubber gloves, surgical mask and protective glasses

Healthcare is a famously motion-intense industry, with entire spin-off industries of comfortable shoes springing up to service the nurses, doctors, and support staff who are always on the move. Your clinic may not be as big as a hospital, but the same rules of motion apply.

Like all process improvement, communication is key. Ask your people their ideas and genuinely listen when they offer them. Their idea could save you money and, even if it doesn’t, the fact that they’re taking the effort to tell you is a sign that you’re on the right track.

 

Where’s your Equipment:

Motion waste is infuriating because it’s so preventable and often comes down to sloppily misplaced items. While the most commonly used items, like tongue depressors, are typically kept in every room, less common items are stored centrally.

Make sure your storage is centralized and organized. For example, if the only pencil available is misplaced or left in an examination room, it could take staff a lot of wandering time to find it. On top of motion waste, this also compounds waiting waste for the other involved staff and the patient, and potentially for subsequent patients.

 

Everything in its Place:

5S is the pillar of Lean best designed to tackle motion waste. It’s a disciplined approach to making sure there’s a place for everything and everything in its place. It also stresses cleanliness and ongoing equipment maintenance, which is universally helpful, even in clinics wherein there are strict best practices.

 

Procedure Prep:

A little motion waste in a process is multiplied by the number of times per day, per week, and per year, repetitively. When you start your process improvement strategy, the most common processes are the lowest hanging fruit to look at for waste.

Clinics perform multiple minor surgeries a day, and each of them requires equipment assembly. This typically can take around 10 minutes, which can then trickle down into waiting waste for patients and other staff.

If your clinic reliably performs that same surgery, consider preparing sterile packs of the most basic items ahead of time. This can save time for the procedure and help eliminate staff congestion at the main storage room.

 

surgery tools, stethoscope

Spaghetti Charts:

Clinic staff are always moving. Doctors are hustling between rooms, front end staff are to and from printers, and nurses are pretty much everywhere.

With all the movement happening, motion waste should be low-hanging-fruit if you know where to find it. A Spaghetti chart is a Lean tool that helps pinpoint motion waste. It works like this:

  • Handout out floor maps of the clinic to every staff member, along with a pen and have them write their names on them.
  • Ask them to scribble down everywhere they walk throughout the day, with a line connecting the “here” and “there.”
  • Afterward, take some time to sit down with each staff member and chat openly about their travels throughout the day.
  • Look for routes that are repeated often and are longer than they should be. Are desk staff having to walk 100 feet repeatedly to the only printer? Is the only store room on the far side of the clinic?

From the Spaghetti chart, and from honest dialogue with your staff, you should be able to pick some low-hanging motion fruit that will build staff confidence and morale in the process improvement journey.

Spaghetti Chart example

An example of a Spaghetti Chart that helps to reduce the waste on transportation, motion and waiting time.

Let’s Talk Spaghetti from Hahn & Houle LLP on Vimeo.

How to Reduce Deadly Waste in Professional Services: Talent

How to Reduce Deadly Waste in Professional Services: Talent

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Talent waste happens when your team isn’t engaged enough in their jobs to give you their creative best. When your doctors, nurses, and front-end staff feel empowered enough to stop you in the hallway with a “what about this,” the win goes to the patient and, by extension, your clinic.

Process improvement can’t happen without your staff. In healthcare, however, burnout poses an exponential threat to medical professionals, heightening not just Talent waste, but increasing risk of misdiagnosis.

 

What is Burnout?

Although not as prevalent in clinics as in hospitals, fatigue and burnout still loom large. Consider that some of your team may have a hospital position or be part of an intensive training program as well as their clinic shifts.

Burnout happens when doctors and nurses become so fatigued that exhaustion becomes emotional. They’ll feel detached from their job and will find it hard to locate any sense of personal accomplishment throughout the day, regardless that they heal people for a living.

At its worst, burnout can lead to difficulty focusing and may even affect meaningful interpersonal relationships. Here’s what you can do about it:

  • Communicate: Be accessible for a few words around the coffee machine or in the hallway. Informal, friendly dialogue has the dual advantage of giving you a read on how they’re feeling and potentially offering one of their few non-medical, social interactions in their work day.
  • Be Respectful: Doctors and nurses know when burnout is happening. It’s up to you to create a culture wherein they feel comfortable reporting it. When they do, it becomes your responsibility to help them however you can. Respect like that can help stop potentially dangerous scenarios before they happen.
  • Prioritize Balance: Medical professionals report a lack of work/life balance more than any other profession. We all need time to detach from workplace pressures. As an extension of the culture of openness you create, try to make time for your doctors and nurses to go to personal events like a wedding, a child’s play, or a weekend away.
  • Facilitate Community: Medical professionals often feel very lonely in their jobs, even when surrounded by patients all day. Encourage social connections where peers can have dinner, grab a drink after shift, or enjoy social interactions that aren’t clinical, and that connect them with people who are probably facing the same work/life issues they are.
  • Audit Barriers: Do your staff face internal obstacles? Look at the forms they’re filling out, the reports they’re writing, and the behind-the-scenes processes that they’re doing daily. While much of that is regulatory and untouchable, some of it is probably just “how you’ve always done it” and potentially wasting time that they could be spending with patients or learning more about their speciality.

hard working medical staff

Lean Thinking

Think about your team one by one. Are there any individuals who, if they felt exhausted, emotionally drained, or frustrated at encountering administrative roadblocks, wouldn’t feel comfortable coming to you or another manager about it?

You’re not making widgets or houses. Healthcare’s product is well being. Lean thinking focuses on how to improve value to the patients across the entire industry.

How to Reduce Deadly Waste in Professional Services: Inventory

How to Reduce Deadly Waste in Professional Services: Inventory

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Reducing inventory waste has a direct correlation on patient wellbeing; the less time doctors and nurses are searching supply rooms, the more time they can spend with patients. In healthcare, fighting inventory waste is as much about organization as it is about how much inventory you have.

 

The Store Room:

Your clinic’s business model will determine the type, volume, and range of medicines and supplies you need to carry. A speciality clinic will need to be stocked deeper in its given field, while an urgent care clinic needs the broadest range to address the massive variety of cases.

Do not neglect store-room organization. Clutter happens fast, leading to increased time wasted looking while patients are left waiting, and potentially resulting in a lack of space when urgent supplies arrive.

 

Have a Tracking System:

What kind of inventory management software are you using? Do its required processes sync naturally with your clinic’s operations, or do your staff have to go out of their way to update it?

If you’re not using a third party to track inventory, how are you doing it? While documenting every tongue depressor is a time waste, losing high-value equipment can add up to massive wasted dollars very quickly.

5S is a pillar of Lean thinking with a disciplined approach to storing and maintaining materials and would adapt well to clinics.

medical professionals counting inventory and doctor at computer

Perishables:

Some inventory combines the unsettling mix of expiring rapidly and being costly. Waste reduction starts with being aware of how the medicines are being used and the context in which people are using them.

If the newest bottles go in front, the ones in the back will expire while those in front are being used, leaving you with the costly waste of throwing away expired meds. Even worse is if, in the clinic’s hustle and bustle, someone grabs a bottle for a patient that is expired.

A Lean approach would be to colour-code labels so that, at a glance, hurried nurses and doctors can grab the right medicine, rather than having to read the fine print on a dozen bottles to find the best one to use.

 

Office Waste:

How many pre-printed intake forms do you keep at the front desk? It may not sound like a serious waste, but if you have 500 forms at a hard cost of about $0.10 each to print, it becomes an investment. Multiply that with how many types of forms you have and it becomes potential waste.

Printing takes nominal time. While printing ahead of time is usually the work of well-meaning front-end staff, here are the downsides:

  • You could change, or be compelled to change, the data fields required
  • They could get lost or damaged
  • They take up valuable real estate at the front desk.

Printing is low-hanging fruit for Just-in-Time Thinking (which stresses creating inventory only when orders warrant it). Print a couple days worth of forms at a time and use the example as a training tool to show your staff how easy it can be to fight waste if we just look for it.

How to Reduce Deadly Waste in Professional Service: Transportation

How to Reduce Deadly Waste in Professional Service: Transportation

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Transportation is the most logistics-oriented waste. It’s the unnecessary movement of materials and, while healthcare isn’t moving tonnes of scaffolding and concrete, the materials being moved are far more precious and delicate.

For sake of comparison between Transportation and Motion waste (the latter traditionally focused on staff), we’re going to zero in on the movement of patients, as well as materials. Healthcare demands that we move patients back and forth and each move required resources. It’s our job to keep asking ourselves whether we’re doing it in the most efficient way possible.

No Value:

Transportation offers no value to the patient. In fact, the longer that any transportation takes, the more potential harm it could cause to patient well-being.

In the medical industry, it’s also one of the wastes that you can cut freely with little restriction from stringent guidelines. More so than other industries, healthcare must navigate complex waters of regulations and red tape when fighting some of the deadly wastes, but this is not so with Transportation.

waiting room and medical supplies

Running Down Hallways:

This waste starts at the beginning: with building layout. Do you need to travel to the other side of the clinic everytime you need a basic medication?

Your storage room should be located near the centre of the action. If it’s not, consider a smaller, secondary storage space for your staff to grab the basics that they need every day.

If there’s medication you’re using all the time, consider bringing it from the pharmacy to where you need it most to avoid travelling to get it. A lot of transportation waste reduction comes down to listing the materials that you use most and streamlining the logistics to get them where they’re needed.

Moving Patients:

Every time a patient moves somewhere, someone needs to prep the room, show him or her the way, and reset the last room for the next patient. Think about all the reasons why you shuffle and shift patients through your clinic. Are they all necessary?

Do patients have to be moved across rooms because specific equipment isn’t available in the first room? If so, could prep be done ahead of time to prep the first room, based on an estimation of patient needs, so 2 rooms don’t need to be prepped and reset from the start?

Perishable Material:

You can’t afford to move samples and other highly perishable materials more than necessary. Make sure that, when they’re taken, they are moved to a central location in the clinic to be dealt with appropriately from there (ie. moved to the lab or examined in-house).

The Other Kind of Waste:

You’ll generate medical waste as a natural part of your practice. Disposing of it is tightly regulated with strict guidelines for non-compliance. Many healthcare providers use a third party company to ensure proper transport and disposal of their medical waste.