Process Improvement Exemplar: Lean Six Sigma in Action


By Frank D. Cohen, MPA, MBB
May 27, 2020

Quite often, when I begin a process improvement project with a client—particularly when it focuses on patient throughput—I like to spend a few hours in the waiting room (reception area) just observing patients come and go and watching the interaction between patients and staff members. 

It’s a pretty normal start to a project like this, and it helps me to get acclimated to the healthcare organization culture and the state of the average patient, if that really exists. I also like to have a stopwatch and a notebook, which allows me to measure waiting time and other important metrics, such as how long it takes a patient to fill out forms or check in at the front desk. When I am lucky, I am able to time an entire patient encounter. 

On this particular day, I was working with a five-physician primary care group in Florida. As expected, the average patient age was somewhere in the range of 55 to 85, which brings with it some unique challenges. While observing, I noticed that new patients seemed to have a particularly difficult time getting through the new-patient intake forms, so I got a packet from the front desk and looked them over. I noticed that the financial responsibility form was quite technical and took up nearly two full pages. Even I had a difficult time getting through it. I noticed that these new patients would interrupt the process of completing the forms by going to the front desk staff to make comments or ask questions. 

In fact, for the nine patients that I observed, all made at least one trip back to the front desk, and four out of the nine made four or more trips. 

At some point, I went to the front desk staff and asked them to summarize for me the questions or comments they were getting from these patients, and a definite pattern emerged. First of all, there was confusion over the financial responsibility form, which didn’t surprise me. But the other issue did. It centered around the patient’s inability to read some portion of the text on the form—not because the print was too small (although it was, at 10-point font), but because these were folks who needed reading glasses but didn’t have any with them. I spent some time later that day going over these issues with the administrator. The first thing we did was to greatly simplify the financial responsibility form. In essence, we removed most of the technical jargon and reduced it to a paragraph that said, more or less, “I agree to be personally financially responsible for any and all charges incurred during my visit today.” Next, we reprinted the packets with a 12-point easy-to-read font (Calibri). But the next fix was my favorite. 

That evening, I went to a Sam’s Club. I purchased a nice woven basket and 20 pairs of reading glasses in different strengths. The next morning, when I got to the practice, I put the basket with the reading glasses on the check-in counter with a sign that said “Forget your reading glasses? Please use one of ours.” 

I was amazed at how many new patients took advantage of the offer that day. And it reduced the visits to the check-in desk from 3.4 to less than 1 per patient. In addition, after doing a two-week experiment, we determined that those changes reduced the average time to complete a new-patient intake packet from 14.4 minutes to just under 8 minutes. 

This was a huge reduction in waste, which ultimately allowed the practice to see three additional patients a day, for a profit of nearly $53,000 annually. And with an investment of about $40. Now that’s what I call process improvement! 

President, The Frank Cohen Group

Clearwater, Florida

Article first appeared in The Journal of Medical Practice Management, Jan/Feb 2020

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