As a rehab therapist, you already expend a lot of energy on optimization—optimization of your patients’ physical, occupational, or speech capabilities, that is. You help your patients be their most perfect, most functional, and most effective selves. But what about your business? Are you working to ensure your practice is as perfect, functional, and effective as it could be? In other words, are you optimizing your clinic—or are there gaps that are frustrating patients and staff and impacting your bottom line?
If you’re leaning toward the latter, you’re not alone. But there are several things you can do to change that—and you can start right now by taking a page from the Toyota Production System playbook. See, we here at WebPT want you to embrace your inner car manufacturer. Just kidding. But we do want you to start trying out some lean principles that Toyota pioneered in the 1930s in order to optimize its production line. In the book Lean Thinking, authors James P. Womack and Daniel T. Jones distilled the principles of lean manufacturing into five points (which we’ve adapted from this source and this one):
- Value: Pinpoint the value your customers want to receive from you.
- Value Stream: Map out the entire flow for each product—all steps from start to finish. Then, pinpoint wasteful steps (i.e., those that do not provide value).
- Flow: Ensure the service or offering flows from start to finish without being interrupted by waste.
- Pull: Change the focus from pushing a service or offering to pulling, which means performing work based on customer need, thus avoiding unnecessary effort.
- Perfection: Aim for perfection to inform a culture of continuous improvement.
Mapping the Value Stream
The Profitable Practice, a blog from Software Advice, has a great article about how to apply lean principles to a physician’s office. We’re going to adapt those how-tos here so they apply to rehab therapists. First, though, a few clarification points:
- As a physical, occupational, or speech therapist, your product is the treatment you provide to your patients, and the value patients receive is functional improvement (or maintenance, as the case may be).
- If you provide entirely different services (e.g., aquatic therapy, therapeutic massage, or gait analysis), you can map the value stream for each offering individually.
- To identify value in any stream, look for anything that a patient would be willing to pay for; steps that do not create value are waste.
- Get your whole team involved—two heads (or thirty) are definitely better than one when it comes to optimization.
Now that we have the basics covered, let’s dive in.
The very first step in mapping a value stream is to identify a process as it stands right now. To begin, create a very high-level flowchart that describes a typical patient’s experience interacting with your clinic. (We drew up a super simple one below using Excel; you also could use software like LucidChart or sticky notes on a wall.)
From there, you’ll want to fill in all of the missing steps—and we do mean all of them. Your Current State Map should account for every second of a patient’s experience as well as all of the steps you and your staff must take to create that experience. Even steps that might seem like one step—such as a patient scheduling an appointment—can be broken down into smaller ones, such as calling the clinic, being placed on hold, and/or receiving an email appointment confirmation. You also should include steps that aren’t meant to be part of the process but regularly are, such as leaving the treatment room to find a hot or cold pack or calling patients who are running late.
After you’ve completed your first pass at the Current State Map, start collecting data to confirm it actually matches a real life patient’s experience. To do so, shadow your patients. In addition to taking notes on every step that occurs from the moment a patient calls to schedule an appointment to the moment he or she is discharged, you also may want to time each step using a stopwatch. That way, you can begin to calculate averages and spot lag times. Some experts recommend adding a symbol to the chart for any time a patient is waiting.
You’ll also notice junctures in the process where patients take different routes based on specific criteria (e.g., whether or not the patient has insurance). You can represent these forks on your map with a decision tree, like this one:
Once you have a complete Current State Map, it’s time to go looking for waste, which, if you remember, is any step that does not provide direct value to your patients (i.e., it’s not something a patient would pay for). According to this definition, documentation, billing, continuing education, and insurance verification are all waste. However, these things are necessary for you to run your practice and get paid; thus, they provide value elsewhere, which means they stay. Steps like patients waiting to receive treatment or your staff performing double data-entry because your EMR doesn’t talk to your billing software are waste with a capital W, which means they’re ripe for elimination—or at least change. Think about what a drain these things are on time, energy, and money, especially when repeated again and again and again.
At this stage, you and your team get to let your imaginations run wild, drop all constraints, and put together your perfect map. In an ideal world, what would the process look like? Go crazy. After you know what perfect is, take a step back and create a plan that you believe is attainable within the next year or so. This is your new goal. Now, it’s time to brainstorm ways you can transform the current process into the future one. Often, small, incremental changes have the most positive, lasting long-term effects. While perfection isn’t actually achievable, aiming for it will keep you motivated to track your progress and continue to identify new ways to improve the delivery of your services.
For some great examples of how real life healthcare professionals have benefited from implementing lean principles, check out the Profitable Practice article in full here. (Hint: benefits include reducing patient wait times, saving money, leaving work at a reasonable hour, minimizing stress, and improving teamwork and camaraderie.)
Sounds pretty good, huh? Have you experimented with lean principles in your clinic? Tell us your experience in the comment section below.