Practice Efficiency, Lean Six Sigma, and Effectiveness

February 17, 2022

It goes without saying that any business can improve in its performance through meeting customer expectations. Simply look at your satisfaction survey results or talk to any patient who has been seen in your office, and they will tell you that things could improve. It is not something that will happen overnight. Rather, it is an attitude that starts with your acknowledgement of the need for improvement.

Your new attitude is what jumpstarts improving your processes, and it leads to continuous process improvement, or CPI. Based on the principles in Lean and Six Sigma management approaches, these approaches originated from the manufacturing world. When discussing with physicians, there is a great deal of skepticism. Manufacturing uses assembly lines, and standardizes the pieces and parts used. Criticism has been that patients are all different, and thus the manufacturing process cannot be applied to the patient care process. This has been proven wrong.

Before we get into the more current thinking, let’s reflect on one of the quality gurus who surfaced after World War II, W. Edwards Deming. An American, Deming helped Japan in its efforts to recover, and set into motion, many of the concepts found in the Toyota Production System - a key in the Lean movement.

Deming identified 14 points that are included in the Deming Chain Reaction. Focusing on improving quality, flowing through the chain will lead to survival of your business. His 14 points are all very valid, even today. Explore how each of these points is relevant to your practice today:

  1. Create constancy of purpose for improvement of product and service –he follows Drucker’s thinking that the mission is not intended to focus on money, but rather on the purpose to stay in business with innovation, research (on business models), and constant improvement. Serve the customer first.
  2. Adopt the new philosophy – a religion where mistakes and negativism are unacceptable. No more waste (wait time), or medication errors, or unsafe environments.
  3. Cease dependence on mass inspection – audits are great, but auditing everything, such as every charge entered into the practice management system, is a waste and unnecessary. Catching defects is costlier than not making them at all. Use audits as teachable moments.
  4. End the practice of awarding business on price tag alone – a statement preceding value-based health care delivery.
  5. Improve constantly. The system of production and service – continuous process improvement, is an improvement philosophy. It is not a onetime thing.
  6. Institute training – create solid onboarding, along with individual and practice wide training programs.
  7. Institute leadership – help staff do a better job through leadership and management improvement programs.
  8. Drive out fear – employees are sometimes afraid to speak up for fear of losing their job.
  9. Break down barriers between staff areas – those are the silos. Departments, other locations, even front desk and clinical areas often function on their own, rather than being part of the entire cycle of care.
  10. Eliminate slogans, exhortations, and targets for the workforce – they simply don’t motivate or help create an improved product, or service for the patient.
  11. Eliminate numerical quotas – a quota is a number, not a method. Don’t encourage staff to complete an arbitrary amount of work. Some are slower and struggle to do it, forgetting about quality over quantity, while others may be efficient and drag work out throughout the day or slack off once their quota has been met.
  12. Remove barriers to pride of workmanship – faulty equipment, poor training, inadequate materials, and the like are barriers to success.
  13. Institute a vigorous program of education and retraining.
  14. Act to accomplish the transformation – emphasis on the quality initiative, and that working together will lead to growth and success.
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