HCI3 Update from the Field: Not a Pipe Dream

Submitted by francois.debrantes@hci3.org on Friday, October 19, 2012 - 12:15

Newtown, CT – October 19, 2012

I see fewer patients a day, spend more time with each, practice costs are down, and revenue is up – That's not a pipe dream, nor is it the statement of a physician in a "concierge" practice. It's from a self-described country doc in Appleton, Wisconsin, and he and his colleagues are practicing in a reengineered environment. The walls are the same, the patients are the same, but the processes used to support the care management teams have been completely rethought and redesigned. Not in a rip and replace manner, but rather focusing on the small things, the minor processes, that create a bunch of rework or waste time. And that's really where the focus should be because reclaiming time for the physician means providing more time for the patient. For example, the practice uses pre-filed and organized "buckets" for a variety of small procedures. Let's say a patient comes in for a routine visit and needs a mole excision. The physician presses a button that alerts the medical assistant he needs some help. A simple request results in bringing in the minor procedure "bucket" which contains everything the doctor needs to perform the procedure. No more rummaging around cupboards or drawers to find supplies. And once the bucket has been used, it's immediately replenished and ready for the next patient. It doesn't seem like much, but let's assume that taken altogether, these minor processes save 5 minutes per patient. At 30 patients per day, that's 150 minutes – 2.5 hours. A huge amount of time regained that the physicians can spend with their family, or with patients.

What this means to you – You don't need an ACO to figure this stuff out, or some fancy name like a Patient-Centered Medical Home. Those are labels and labels peel off. What you need are the basics of Lean/Six Sigma applied to every practice and every hospital, chipping away at waste…not just wasted resources, but wasted time for the clinicians and the patients. One of the more enlightening revelations in that ThedaCare practice was to start doing tomorrow's work today. In other words, if you have regained time, you can start prepping for the next day's caseload. The clinical staff can look at charts ahead of time, plan for lab tests that will be needed, highlight gaps in care that should be taken care of. Instead of the mad scramble on the day of, you have time to plan. And every day gets better and easier, as long as you accept that improving processes is never a job done. That's because something will come up. As Jack Welch used to say, "bureaucracy is like a weed, it always comes back and you have to root it out again." Of course, not every practice might know how to apply Lean/Six Sigma, or have the resources. But in almost every community there's a small, medium or large company that has those skills, and we need to collectively figure out how to transfer them, because it's in the direct best interest of those companies to see that practices and hospitals get their processes redesigned. Any volunteers?


Francois de Brantes
Executive Director
Health Care Incentives Improvement Institute, Inc.
w: www.hci3.org