Make Your Clinics Flow with Synchrony: A Practical and Innovative Guide for Physicians, Managers, and Staff

By Dennis Han and Aneesh Suneja

Synchrony is the ability of a healthcare process to control the pace of the physician process and the pace of the patient process such that the physician and patient are ready for each other at the same time, without waste or delay. When a process achieves synchrony, the patient does not wait for the doctor, nor does the doctor wait for the patient.

Dr. Dennis Han is an ophthalmologist specializing in diseases of the retina at the Medical College of Wisconsin and Froedtert Memorial Hospital; Aneesh Suneja is an engineer and lean consultant who worked with Dr. Han to transform his practice. With the help of Suneja, Han’s patients experienced an 85% reduction in non-value added wait times, and a corresponding 97% “top box” rating on patient satisfaction surveys (“strongly agree to recommend this doctor’s office to others”). Financially, his practice saw a 25% year-over-year increase in relative value units (RVU) production and a 41% increase in payments due to increased physician availability.

If you are a physician, clinic manager, administrator, technician, or provider of health services in a clinic setting, you can use the guidelines described in this book to effect a transformation as well.

"Thank you, doctor Dennis Han, MD, and co-author Aneesh Suneja, MBA, for this marvelous work that applies Lean principles in healthcare settings. The focus on physician medical clinics is a brave venture into this complex, hectic world that has traditionally been dominated by physicians with a predominant emphasis on patient volume, and subsequent billing volume, versus caring for their customers… This important work is essential for just about all existing physician clinics." Dale Farris Healthcare quality improvement specialist with 25 years experience.

"Lean principles have opened up more slots for patient care allowing better clinic and staff utilization, and have increased patient throughput while reducing employee overhead and burnout. There is a joy on the faces of the staff when they get to leave the office earlier than expected because lean principles have been deployed." Jose Martinez, MD Practicing physician and beneficiary of the “Synchrony”

"Physician office managers and their medical staffs would be the primary targets for this book. However, I also see it being applicable to the higher educational setting…[such as in colleges and institutions teaching healthcare improvement.]" Jim Bente Vice President, Planning and Institutional Effectiveness, College of duPage Adjunct Faculty, Carnegie Mellon University

• Language: English
• Publisher: ASQ Quality Press
• Release date: Jan 11, 2016
• ISBN: 9781953079626

Book preview

Make Your Clinics Flow with Synchrony

Also available from ASQ Quality Press:

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The Lean Doctors Workbook: An Application Guide for Transforming Outpatient Clinic Systems with Lean

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The Lean Handbook: A Guide to the Bronze Certification Body of Knowledge

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The Certified Six Sigma Green Belt Handbook, Second Edition

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The Certified Manager of Quality/Organizational Excellence Handbook, Fourth Edition

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The ASQ Auditing Handbook, Fourth Edition

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The ASQ Quality Improvement Pocket Guide: Basic History, Concepts, Tools, and Relationships

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To request a complimentary catalog of ASQ Quality Press publications, call 800-248-1946, or visit our website at www.asq.org/quality-press.

Make Your Clinics Flow with Synchrony

A Practical and Innovative Guide for Physicians, Managers, and Staff

Dennis P. Han, MD

Aneesh Suneja, MBA

ASQ Quality Press

Milwaukee, Wisconsin

American Society for Quality, Quality Press, Milwaukee 53203

© 2016 by ASQ

Library of Congress Cataloging-in-Publication Data

Names: Han, Dennis, author. | Suneja, Aneesh, 1968– author.

Title: Make your clinics flow with synchrony : a practical and innovative

guide for physicians, managers, and staff / Dennis Han, MD, Aneesh Suneja,

MBA.

Description: Milwaukee, Wisconsin : ASQ Quality Press, 2016. | Includes index.

Identifiers: LCCN 2015043405 | ISBN 9780873899239 (hard cover : alk. paper)

Subjects: LCSH: Medical offices—Planning—Handbooks, manuals, etc. |

Physician and patient.

Classification: LCC R728 .H353 2016 | DDC 610.68—dc23

LC record available at http://lccn.loc.gov/2015043405

ISBN 978-0-87389-923-9

No part of this book may be reproduced in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the publisher.

Publisher: Lynelle Korte

Acquisitions Editor: Matt T. Meinholz

Managing Editor: Paul Daniel O’Mara

Production Administrator: Randall Benson

ASQ Mission: The American Society for Quality advances individual, organizational, and community excellence worldwide through learning, quality improvement, and knowledge exchange.

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To place orders or to request ASQ membership information, call 800-248-1946. Visit our website at http://www.asq.org/quality-press.

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We dedicate this book to our wives Mary Lynn Han and Cary Suneja.

List of Figures

Figure 1: Synchrony diagram—target state.

Figure 2: The A3 problem-solving form.

Figure 3: A simple process map for data collection.

Figure 4: Percent load chart prior to intervention.

Figure 5: Percent load chart after initial intervention.

Figure 6: Silo effect from processes performed in series.

Figure 7: Patient status board.

Figure 8: Dependent versus parallel steps.

Figure 9: Reducing dependency to reduce variation effects.

Figure 10: Patient movement in Dr. Han’s injection clinic prior to lean changes.

Figure 11: Multifunctional team/single-use rooms.

Figure 12: Multifunctional team with flexible treatment rooms.

Figure 13: Technician movement before relocation of OCT equipment.

Figure 14: Technician movement after relocation of OCT equipment.

Figure 15: Common work area in the hub-and-spokes model in an ophthalmology clinic.

Figure 16: Floor plan of exam room in an ophthalmology clinic using the hub-and-spokes model.

Figure 17: The implementation stepladder for Dr. Han’s clinic.

Preface

This book is about the radical notion that the patient’s time in any healthcare process is as valuable and as important to process improvement as the physician’s. When the patient is seen in this light as a resource to be managed, the process can achieve what we have come to call synchrony. Synchrony means valuing the patient’s time and the physician’s time equally, bringing them together when each is ready for the other, without waste or delay. To make clinics flow, or, for that matter, any other process that joins physicians with patients, synchrony is fundamental.

For years, those of us in the process improvement field in healthcare have put physicians in a spotlight. After all, physicians are shared resources—constraints on healthcare processes—whose time has to be managed in such a way as to create flow and prevent bottlenecks. Lean tells us that every process has a constraint: a step that sets the pace of throughput for the process as a whole, and can create backlogs and bottlenecks when not managed properly. Find that constraint, manage its time, and we can make that process more efficient and effective. In healthcare, physicians are not only shared resources, they are the ones who create processes, wield authority, and influence the work environment of the rest of the care delivery team. It made sense to focus our attention on the roles physicians play and how to best manage their time as shared resources.

And yet, despite the attention paid to the physician as the resource to be managed, the problems and dysfunctions experienced by frontline care teams—nurses, medical assistants (MAs), technicians, and others who support the doctors—persist. We hear time and time again about interpersonal problems on care teams, problems with team communication, conflicting directions for work depending on the doctor giving the orders, competing priorities when new or emergency patients are added to an already full schedule, and frontline staff who feel like they have no voice or ability to suggest improvements. These issues are raised not just by the team involved in direct patient care, but by managers and administrators as well. As important as it is to improve the physicians’ processes and focus the team’s efforts on supporting those processes, those actions alone will not solve all the problems that plague teams in healthcare.

The issues described above are impossible to resolve permanently when addressed one at a time, in isolation. We cannot resolve interpersonal tensions in a broken system that distributes work unevenly, nor can we give people a voice in an environment that does not acknowledge their contributions. But when we broaden the focus of improvement efforts to include the patient’s time as an equally valuable resource and work to achieve synchrony, we can fundamentally improve healthcare processes and the lives of the people who operate them. That is because when we make improvements that positively impact the physician’s ability to do her job, and at the same time improve the patient experience, everyone involved sees the ­benefit, and a host of related problems can be solved.

We have lived the journey to synchrony from two distinctly different points of view: Dr. Dennis Han is an ophthalmologist specializing in diseases of the retina at the Medical College of Wisconsin and Froedtert Memorial Hospital; Aneesh Suneja is an engineer and lean consultant who worked with Dr. Han to transform his practice. Physicians and other healthcare providers generally are trained in the science of medical care rather than in the science of caring for patients. This is an important distinction—medical schools do not