Conducting and Implementing Successful Efficiency Projects

1
Conducting and Implementing Successful Efficiency
Projects

• Christian Baldwin, FACMPE

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Objective for Todays Session

• You will be able to use basic manufacturing
  process-improvement techniques and apply process
  mapping and simulation approaches to your
  organization.

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The Intersection of Operations and Finance

• Terms and definitions
• Capacity
• Productivity
• Practice efficiency is vital because
• Increasing capacity increases revenue
• No expense of facility expansion or capital
  outlay
• Increased productivity increased capacity
  increased profitability

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Capacity and Profit
Ogle, John. The Oncology Practice of Tomorrow
Optimizing Operating Efficiency, November 19 and
20, 2004 Barry Fortner, PhD, Christian Baldwin,
John Ogle, CPA.
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Revenue and Expenses

• Under efficient systems, additional revenue
  streams can be supplied by the existing workforce
• Fixed costs stay constant
• All practices are seeing higher costs and most
  are seeing lower reimbursements

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Focusing on Efficiency
Ogle, John. The Oncology Practice of Tomorrow
Optimizing Operating Efficiency, November 19 and
20, 2004 Barry Fortner, PhD, Christian Baldwin,
John Ogle, CPA.
7
Lets Take a Trip

• Airlines analogy
• Fixed number of seats
• A limit exists
• Capacity is known
• People understand the time involved and rules
  with flying
• How many patients can you squeeze into the
  schedule?

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Question
What if our plane is too full?
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Answer
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Scheduling

• Middle of the day bottlenecks
• Misalignment of resources
• Individual thinking instead of global scheduling
• Two part problem
• Operations
• Culture
• We do not know what our current capacity really is

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When Scheduling Ask

• What resources are needed?
• How long is each resource needed?
• Which resource is the primary concern?
• Do any other legitimate concerns exist?
• What order should the resources be scheduled?

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Process Improvement Projects

• Define opportunity
• Measure baseline information
• Process map
• Data collection
• Analyze data
• Improve performance
• Implement solution
• Controls for ongoing improvement
• Dashboard
• Feedback

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Process Lifecycle
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Example Efficiency Project - Definition

• How
• Compare arrival times to appointment times
• Demonstrate how early or late patients arrive
• Compare check in time versus time patient called
  from waiting room
• Compare time patient entered versus time provider
  entered
• Who, When, Where
• Patients
• Providers and staff
• Now
• Your office locations

• What
• Patient arrival patterns
• Patient wait times
• Waiting room
• Exam room
• Why
• Identify disruption to patient flow
• Understand and improve capacity
• Schedule efficiently
• Reduce wait times
• Increase staff and provider productivity
• Increase profitability

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Measure for Baseline

• Process mapping
• Patient flow
• Workflow
• Data needs
• Appointment time
• Arrival time
• Time patient called back
• Time patient entered exam room
• Time provider entered exam room

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Analyzing Data Arrival Patterns
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Analyzing Data Wait Times

• Minimum wait time
• Maximum wait time
• Average wait time
• Range in wait time

• Sigma level (measure of variation of wait times
  compared to goals)

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Improve Efficiency

• Now with a baseline understanding, work to
  improve efficiency
• Brainstorm
• Construct or adhere to policies
• Simulate if necessary
• Work for small wins not insurmountable gains

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Implementing Success

• Forces for change
• Nature of the workforce
• Technology
• Economics
• Competition
• Social trends
• Politics

It is not necessary to change. Survival is not
mandatory. - W. Edwards Deming
Robbins, Stephen. Essentials of Organizational
Behavior, 8th Edition, Prentice Hall, Upper
Saddle River, NJ, 2005 p 265.
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Resistance to Change

• Individual resistance
• Habit
• Security
• Economic factors
• Fear of the unknown
• Selective perceptions

• Organizational resistance
• Structural inertia
• Limited focus of change
• Group inertia
• Threat to
• Expertise
• Power
• Resource allocations

Robbins, Stephen. Essentials of Organizational
Behavior, 8th Edition, Prentice Hall, Upper
Saddle River, NJ, 2005 p 269 - 71.
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Overcoming Resistance to Change

• Reward acceptance of change
• Create a learning organization
• Communicate
• Participate
• Provide support

Robbins, Stephen. Essentials of Organizational
Behavior, 8th Edition, Prentice Hall, Upper
Saddle River, NJ, 2005 p 271 - 72.
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Control Processes for Continued Success

• Review processes monthly
• Constantly improve
• Always work to increase efficiencies even if it
  is a little bit at a time
• Make it fun
• Small project success will help you implement
  larger change such as EMR installations or new
  building design