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.

Current State

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:

Waste

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.

Perfection

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.

The PT Patient’s Guide to Understanding Insurance - Regular BannerThe PT Patient’s Guide to Understanding Insurance - Small Banner
  • What's the Right Payer Mix for Your Practice? Image

    articleJul 17, 2018 | 6 min. read

    What's the Right Payer Mix for Your Practice?

    Insurance payments for healthcare services have been declining for a while now , which means providers in all disciplines are looking for ways to optimize their payer mix in order to maximize their revenue. If you haven’t yet calculated the cost of providing your services—and compared that number to the payments you’re receiving to ensure you’re actually making enough money to not only cover those costs, but also turn a profit—then you should. But the question remains: …

  • The State of Rehab Therapy in 2018 Image

    downloadJun 28, 2018

    The State of Rehab Therapy in 2018

    To say that the healthcare industry is complex would be an understatement. While the advent of technology has made care more precise, efficient, and collaborative than ever before, it has also put greater pressure on providers to deliver high-value care at scale. After all, big data makes it possible to not only develop the most effective, evidence-based best practices for individual diagnoses, but also form evidence-based strategies for managing the health of populations. In the spirit of …

  • Down with Denials! 5 Claim Fixes to Make Sure Your PT Clinic Gets Paid Image

    webinarApr 19, 2017

    Down with Denials! 5 Claim Fixes to Make Sure Your PT Clinic Gets Paid

    One denied claim might not sound off your billing alarm bells—but in reality, it should. That’s because—as with faulty plumbing—one leak often indicates a much larger issue. And all too often, rehab therapy practices fail to act quickly enough—and soon find themselves wading in a flood of lost revenue. But there are simple, proven, and affordable ways to not only plug your billing holes, but also reinforce your whole system so you’re less likely to bust a …

  • The Case for Care Cost Transparency in Your Practice Image

    articleApr 26, 2017 | 6 min. read

    The Case for Care Cost Transparency in Your Practice

    Back in the day, the notion of healthcare providers discussing the cost of treatment with insured patients was relatively unheard of. After all—aside from a nominal patient copay—insurance usually footed the bill. That’s not the case today. As Fair Health President Robin Gelburd writes in this Physicians Practice article , the insurance industry has evolved to place greater financial responsibility on patients—hello, high-deductible health plans (HDHPs). As a result, patients want to know the cost of the …

  • 4 Keys to Keeping a Steady Cash Flow Image

    articleMay 18, 2016 | 5 min. read

    4 Keys to Keeping a Steady Cash Flow

    As a private practice clinic owner, you’re probably familiar with the cold sweat-inducing struggle to keep a steady cash flow. Claims management muck-ups, inefficient processes, staff issues, and lack of insight into your clinic’s financial health can leave you feeling like you’re riding a revenue rollercoaster. So, whether you’re trying to maximize reimbursements , combat employee theft , or optimize patient payments , these four keys to maintaining a steady cash flow will help you even out …

  • 6 Crucial Conversations to Have with Your Patients Image

    articleJan 2, 2018 | 7 min. read

    6 Crucial Conversations to Have with Your Patients

    Good communication is one of the cornerstones of a great relationship—whether that be a relationship with a significant other, friend, or patient. We’ll keep our non-patient relationship advice to ourselves, but when it comes to patients, it’s absolutely imperative that physical therapists have the right conversations—at the right times—to keep patients informed, engaged, and happy. To that end, here are six crucial conversations you should be having with every patient throughout the course of care: 1. The …

  • The Surprising Metric That Will Help You Set the Right Patient Load Image

    articleFeb 4, 2019 | 5 min. read

    The Surprising Metric That Will Help You Set the Right Patient Load

    Burnout impacts professionals in all industries, but it’s becoming particularly rampant in health care, with providers and administrators constantly struggling to juggle insurance and documentation requirements with business operations and patient needs. As a team lead, manager, or clinic owner, you undoubtedly want to protect your staff from burnout—while also optimizing their performance to maximize revenue . After all, your therapists won’t have a practice to work in if you don’t earn enough money to keep the …

  • MCIDs: What Are They, and Why Do They Matter? Image

    articleDec 28, 2017 | 3 min. read

    MCIDs: What Are They, and Why Do They Matter?

    Things aren’t always as they appear, and that’s certainly true when it comes to measuring the success of rehab therapy treatment. As any therapist knows, if you make decisions based on observational data alone, determining whether or not your treatment is making a difference can prove difficult. That’s why outcomes exist: they give therapists an objective, concrete way to measure patient improvement. But, a positive outcome score isn’t necessarily enough to tell you that your physical therapy …

  • How to Stay in Business in this Uncertain Healthcare Environment Image

    articleJun 29, 2017 | 17 min. read

    How to Stay in Business in this Uncertain Healthcare Environment

    Health care as we know it is changing. But that’s nothing new, right? Health care has been in a state of flux for a while now—what with ever-changing payer regulations and the steady push toward more patient-centric, value-based collaborative care. And while putting patients first is surely good for everyone, increasing regulations—and decreasing reimbursements—can make it challenging for providers to keep up, let alone keep the lights on. That’s why we’ve spent much of this quarter discussing …

Achieve greatness in practice with the ultimate EMR for PTs, OTs, and SLPs.