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
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.
by The HLH Team
In Manufacturing, overproduction is a potentially paralyzing waste that happens when too many widgets roll off the line. In a clinic, care is the product. But too much of it, or wrong administration, can yield massive resources waste.
Tests, Tests, and more Tests:
When a doctor decides to order a patient test, it’s because he or she feels that a piece of the overall puzzle is missing. This is usually a gut feeling.
Overproduction happens when more resources are spent on tests than what the patient needs. Here’s what that looks like:
- Ordering tests that offer no valuable insight into the patient’s condition and are thus unnecessary
- High cost tests when less expensive tests would yield the same answers for that patient
- Extra diagnostic testing in order to insulate against potential claims of malpractice, often in relation to a difficult patient
Drugs:
Doctors write dozens of prescriptions a day for a wide array of drugs. The balancing act here is to provide the amount required for appropriate care, but no more.
Chronic overuse of antibiotics over decades has resulted in deeply-rooted health issues, like emergent superbugs. Sometimes it’s habit to prescribe antibiotics for illnesses that will pass on their own.
It can be difficult, especially when a patient books an appointment looking for the pills, to leave it at bedrest. Often in healthcare overproduction, the patient is the driving force, asking for more than he or she needs, which puts the doctor in the unenviable position of having to take time to educate when other patients are waiting.
Other questions to consider when prescribing:
- Does the patient need the brand name, or will the generic have the same effect? If the patients asks for the brand name, what should the doctor’s role (if any) be in education?
- A lot of patients don’t respond favourably to the first drug tried. What dosage are you prescribing at the beginning, and is it going to waste?
Staffing:
Wastes overlap in every industry. In a clinic, over-processed tasks, whether at the front desk or with patients, could result in your clinic being unnecessarily over-staffed.
Every industry grapples with staffing levels. If yours are bugging you, focus on the internal processes your team performs many times a day. If your peak staffing levels are at slow patient times, there’s a lot of non-patient involved over-processing happening.
Defensive Medicine:
Defensive medicine is on the rise, and overproduction waste is rising with it. More patients are marching in with “WebMD” diagnoses in-hand, looking to inform rather than dialoguing with doctors. Often they demand certain medications, tests, or procedures that they think they need, and it falls to the doctor to try reasoning with them, while attempting to assess their condition objectively.
It’s called “defensive” because patients, sometimes with threats (implied or otherwise) of publicity or legal action, are on the offensive. It can sap doctor morale, waste resources, and decrease overall patient value across the system. It’s also a fairly new cause of overproduction, with a largely unclear trajectory.
by The HLH Team
In most industries, a defect waste means repair costs, potential reputational damage, and, if public safety is affected, a potential recall. In healthcare, it means patients stay sick, get sicker, and may even die.
Misdiagnosis:
Misdiagnosis is the granddaddy of all defects, and the consequences can be deadly. On top of the potential cost to your patient’s well-being, your clinic could be sued and a massive blow could be dealt to your reputation.
Here are a few of the most common causes of misdiagnosis:
- Doctor Subjectivity: We’re all human, and sometimes we have built-in judgements when meeting people. If a doctor has any personal feelings toward a patient, positive or negative, they have the potential to cloud judgement. Personal awareness on the doctor’s part (and acceptance that exists with it) is vital.
- Poor Communication: This could be either inadequate doctor-patient communication or incomplete communication between medical professionals. The best way to deal with this is to slow down. Take a breath and make sure that the other party hears you, feels heard, and that both sides have a chance to synthesize the information before hustling onwards. Everyone is busy, but making sure we understand the facts is one of the most important jobs in medicine.
- No Fault Errors: This is when a patient deliberately undermines the diagnostic process, likely by providing false information. Motives vary, but keeping vigorous notes is the best defense.
- System Related: This could be due to a number of things, from a faulty test (human-caused or otherwise), incomplete medical training, or an organizational failure. Audit these processes one by one to make sure they’re appropriate.
- Incomplete Judgement: Like communication, this is largely caused by rushing. Unlike communication, it concerns only the doctor. Every patient presents a puzzle and the Doctor doesn’t know how important each piece is until they’re together. Family history, test results, and, of course, current conditions all play their part. If the doctor rushes when putting the puzzle together, he or she may miss the significance of an important piece. The key here is to give your doctors the breathing room they need to be able to make the right decision.
Data Entry:
Healthcare has its share of administrative defects. Some of these, like typos from entering handwritten intake forms, are low hanging fruit.
Have a tablet available for those willing and comfortable to fill out their form. Every time data passes through human hands especially when interpreting handwriting, the chance for defects increases. Eliminate the extra step and you’ll trim waste.
Prescriptions:
Closely related to misdiagnosis, writing the wrong prescription or issuing the wrong medicine at the pharmacy can have the same deadly results. Luckily, these instances are rare; more often, the defect at the pharmaceutical level is the pharmacy technician miscounting pills.
Give them permission to slow down and count again. Remember, if a patient calls claiming that they got 88 pills instead of 90, the worst thing you can do is call them a liar. Treat them with respect and, once you’ve dealt with their issue, chat with the pharmacy technician in a respectful way to see if it was a one-time accident or if there may be issues of fatigue or personal stress at play.
