Stop “pushing” your patients aroundImplementing “pull” in your medical practice

workflowdiagnostics.com 1-855-FLOWDOC

presents:

“WIP” – Excessive Work-in-Process• Created by “push”• Creates waste – waiting, overutilization,

overprocessing• There is no limit to WIP – other than the number

of exam rooms, waiting room chairs, etc.• Requires energy and space to manage• Excess inventory indicates excess capacity

• Consider: Where is / are the constraint(s) in the system?• Typically: The “examination” process, i.e. the MD

Pre-Physician Process

-Arrive / Sign-in-Registration

-Check-in

Physician Process

-Exam-Interpretation

-Notes

“PUSH” PATIENTS

Here’s what’s happening now:

Back

log

Pat Pat Pat Pat

Waiting Room Exam Rooms

“Push” & WIP Explosion

• Complete work and “push” patient to next step• Empty rooms must be filled• Temptation to truncate work on each patient (e.g. note)• WIP requires constant attention and energy to monitor,

not to mention space to accommodate• Wait time spread throughout the system• Up-and-down, stop-and-start

Pat Click once for each patient

Here’s what could be happening: “Pull” & WIP Cap

Pre-Physician Process-Check-in

-PFT or CXR

Exam Room 1-Exam

-Interpretation-Notes

MD “PULLS” NEXT PATIENT (1) INTO CHECK-IN PROCESS*Isolates all waiting to waiting room,

where it can be seen & lopped off

• Patients are “pulled” through the process by MD – e.g. MD entering room triggers next check-in

• MD (constraint) sets rate of production (Takt time)• Characterized by level flow & one-piece flow

– Physician completes one patient and previews next while check-in & procedure are performed

– 2-cylinder engine

Pat Pat

Exam Room 2-Exam

-Interpretation-Notes

Pat

EXIT

Pat

Pat

MDClick one time only

Benefits• Reduced WIP and the energy & resources to manage– Fewer rooms needed– Less travel; more order– Better resource availability– Less waste

• Clarity & simplicity – Who’s next, where to go, who’s waiting, where are they, etc.

• Rhythm & flow• Lower cycle times• All the work finished, every day

Strategy• Need 5 things:

1. Constraints management – find the bottleneck(s) and do everything possible to help him/her move more quickly

2. Visual workplace – cues, indicators, shared metrics3. Standardization coming into & out of exam room4. One-piece flow mindset5. Identify level flow, e.g. Non-physician vs. physician

processes – Implement trigger for work upstream• WIP cap, e.g. authorization card w/ doc’s name

Pilot with one MD’s simplest, most routine patient set

Thank You!

WorkflowDiagnostics.com1-855-FLOWDOC

Twitter: @workflowdx

Contactus:

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