Using Lean and Six Sigma to improve clinic and patient flow

As technologically advanced as modern healthcare has become, the patient experience still relies on staffs and physicians to work in cooperative and coordinated fashion – which isn’t always the case, unfortunately. 

Adrienne Lloyd, MHA, FACHE, is a speaker, consultant and coach, in addition to serving as Chief Administrative Officer, Ophthalmology, with the Duke University Health System. She’s become a recognized expert and trainer for practice optimization and cultural transformation. 

Lloyd spoke with Sr. Editor Daniel Williams on the MGMA Insights podcast about using managerial processes like Lean and Six Sigma to complement administrative goal-setting for staff and to increase clinic flow optimization. Though the philosophies were first developed in the automotive manufacturing business, Lloyd said their ideas can work just as effectively in a fast-paced healthcare setting, as she found during a decade working with the Mayo Clinic. 

“Lean and Six Sigma can be used independently or together, but they both focus on the customer, which in healthcare is focusing on the patient,” said Lloyd, who spoke at MGMA20 | The Operations Conference Online. “Lean really looks at trying to reduce the waste in the process, either waiting time or processing time or reducing handoffs or the collection of too much information. Six Sigma, on the other hand, focuses on standardization and reducing variations – like lab tests, trying to get that really high-consistent output for products and processes.”

Like any efficiency-building effort, Lloyd said both tools can be phased in slowly to try to turn around workflow and put staff and resources in the right place.

“I usually recommend starting with Lean to try to map the process and see if there’s areas to cut out an entire step or component, rather than trying to make something perfect when you may be able to get rid of that whole step in the first place,” she said. “And then Six Sigma can be used to standardize those steps of the process that you still feel are really value-added, from the customer perspective.”

Both strategies can be helpful, as optimizing efficiency in a complex health system isn’t easy, Lloyd admitted, even with all of the technology, communications systems and highly trained personnel. And in a larger system, where specialists rely on other departments to process and transfer patients in a timely manner, Lloyd said things can fall apart quickly. She evoked the famous image of Lucy and Ethel desperately trying to keep up on a production line. 

“A lot of times in healthcare, I often show that ‘I Love Lucy’ chocolate factory video, where we’re just kind of shoving patients in,” she said. “You know, we have them all show up at 7 o’clock, and meanwhile, we don’t have enough staff to even touch the patients until 8 o’clock. So, you’re trying to create a pull system so that the patient is ready when the physician’s ready to see them.”

In looking at broader ideas she’s used with her own healthcare employers, Lloyd said the secret is to examine the process and, in many instances, go in reverse to try to maximize efficiency at every stage, through enhanced training and higher expectations.

“We looked at the time it was going to take the technician to do that workup and then we were able to work backwards and build the schedule,” she said. Once we did that, we made significant improvements in improving the flow and reducing the wait time for the patients. It also allowed us to expand the patients the providers were able to individually see and our staff were able to accommodate. That was a game-changer for us. Really focusing on training your staff, challenging them to learn and creating an environment where they know what the expectations are. Having that kind of consistency as a leader, setting those expectations and then reconfirming those with your staff, is so important.”

Lloyd said the move to value-based care has resulted in a cultural transformation that also can’t be achieved overnight, so she cautions administrators to be realistic in their approach. She mentioned the “80/20” strategy as a realistic benchmark for achieving efficiency.

“We all have day jobs. We all have patients that are coming in on a minute-by-minute basis. And when you’ve got so many initiatives, it really is almost impossible to make significant movement on all of them,” Lloyd said. “And, of course, when you don’t see movement, it’s frustrating as an administrator, and for the staff and the physicians as well. I just think you can try to streamline and focus on the processes that really impact the majority of your patients and your practice. If you can make that process efficient for 80%, you’re going to end up having more flexibility for those patients that are more complex and need more time. But if you try to make a perfect process for all the possibilities that are coming through the doors or all the initiatives and KPIs that you need to hit, it’s really hard to move the dial and get the engagement.”