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Applying Lean Principles to the Provider Recruiting Value Stream.
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Transcript of Applying Lean Principles to the Provider Recruiting Value Stream.
Multi-Specialty Group in the Southeast
Asked us to participate in vendor management system• Further discussions uncovered:– Undefined process– Desire to save $– Desire to “do it better”
• Introduced client to Lean which resulted in:– Reduced fill time by 22%!– Eliminated 24 steps in process! – $2.5 Million in additional revenue/year!
What if you could…
• Reduce the amount of time it takes you to respond to potential candidates from 64 hours to 7 minutes
• Take back or free up 20% of your work week• Reduce your credentialing and 3rd party payer
processing times from 84+ days to 42 days• Reduce the average time to fill an open
position by 32 days
What is Lean?
• A methodology to improve operations through:– Relentless attention to detail (quality)– Commitment to data-driven experimentation– Empowering employees to eliminate waste in
their jobs
Specify Value
• What actions do I perform that provide value to my customer (from their perspective)?
• Would my customer be willing to pay for the time/materials associated with each action in my current process?
Value Stream
• A value stream is the set of all the specific actions required to create and deliver a product or service (or a combination of the two) to your customer.
• In our case – What actions do you perform in order to ensure that your patient population has access to medical care when needed?
• Identify the entire value stream for a given deliverable.• Allows you to begin to uncover and eliminate waste in
your workflow.• If it can be measured…
Value Stream Map
• Low tech approach – doesn’t need to be glamorous
• Always by hand, in pencil• Walk the flow– Flow of materials– Flow of information
Create a VSM – Morning Routine
• Draw a box for each step of your morning routine• Connect the boxes with arrows, in the order you
perform each step• Indicate time spent for each step• Indicate time spent waiting between steps• Indicate if each step provides value• Create a table that totals the results
Shower Facial Hair?
Yes
No
9 min 0-15
# Steps 2
Time: 12-27
Waste: 0-15
Value: 12Shave
3 min
Morning Routine VSM (Current State)6:20
Alarm Snooze 6:25 Alarm Snooze 6:30 Alarm
Shave Teeth Hair Clothes
Breakfast Arrive at work
Drive to Carpool
Lay in bed Check Email
Get out of bed Shower Facial
Hair?
Yes
No
Late?
Hungry?
No
Yes
Yes
No
5 min 5 min
5-10 min 5 min 9 min
3 min 2 min .5 min 6 min
5 min 4 min
Drive to Work
30-40 min
.5 min
0-15
# Steps 13
Time: 80-110
Waste: 20-50
Value: 60-70
VSM
• Based on current state:– Are there obvious actions that can be eliminated?– Can items be rearranged or integrated into others
to create efficiency?– What waste can I identify in the process?– Are there areas in the process that are necessary,
but can be changed to become more efficient?• Create a Future State VSM
Future State VSM7:00
Alarm
Arrive at work
0-5
Get out of bed
.5 min
Shower
5 min
Teeth
2 min
Hair
.5 min
Clothes
2 min
Drive to Carpool
4 min
Drive to Work
30-40 min
# Steps 7
Time: 44-59
Waste: 0-15
Value: 44-54
# Steps 13
Time: 80-110
Waste: 20-50
Value: 60-70
• No more snooze• Shave on Sundays• Eat fruit at work• Select clothes prior night• Look at carpool process
Before After
Provider
Provider
Provider
Provider
Value Stream – Provider Perspective
Recr
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Med
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Dep
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Cred
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Adm
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Anci
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Dep
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3rd P
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Age
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Mar
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Value Stream – Departmental Perspective
Recr
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Med
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Dep
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Cred
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Patie
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Adm
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Anci
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3rd P
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Provider
Provider
Provider
Provider
Recr
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Med
ical
Dep
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Cred
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Patie
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Adm
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Anci
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Hum
an R
esou
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Mar
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gIntegrated Value Stream
Recr
uitin
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Med
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Dep
artm
ents
Cred
entia
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Patie
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Com
mun
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Adm
inist
ratio
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Anci
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3rd P
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Provider
Provider
VSM Success Story
Hospital in Southeast US• Expressed frustration with lack of time during
the week to do the “things that mattered”• With completed Value Stream Map:– Apparent waste made obvious– Uncovered key behaviors that stifled productivity– Allowed us to create a “go forward” strategy– Re-captured 1 day per week
The same old way?
• To this point, it’s been about “understanding”, now it’s time to make changes
• Create a culture of continuous improvement– Catalyst– Local and Executive Champions
• Change is a threat when done to me, but an opportunity when done by me– Empowerment/Involvement
Kaizen
• To change something and make it better– Continuous Improvement
• A group of methods for making work process improvements– Cross functional– Rapid implementation– Low cost
Identify 7 Types of Waste• Defects
– (Data entry or invoicing errors)
• Overproduction– (Printing forms that may change before use)
• Inventory– (Literature, office supplies, unread email)
• Extra Processing– (Duplicating data, unused reports, relying on inspections instead of process)
• Motion– (Walking to printer, looking for missing information)
• Transportation/Handling– (Movement of paperwork, the infamous “forward/respond to all”)
• Waiting– (Approvals, clarification, information)
Tennis Ball Exercise
• Each table is a team• We’ll play 3 Rounds• Each group will use 3 tennis balls• At the end of each round there will be a brief
discussion• Each round is timed by the facilitator – pay
attention to your facilitator• No practicing between rounds
Rules• Each team must stand in a circle• Each person must touch each ball once• All 3 balls have to start and stop at the same
person• You are not allowed to throw the ball to the
people standing directly next to you• 2 people cannot touch the ball at the same time• One person cannot touch 2 or 3 balls at the same
time• Your process must be repeatable (3 rounds)• A dropped ball is a quality defect and you must
start over (timer keeps going)
Round 2 Rules• Must keep the same order from Round 1• Do not have to stand in a circle• Two people cannot touch the ball at the same
time• One person cannot touch 2 or 3 balls at the
same time• Must be repeatable• A dropped ball is a quality defect and you must
start over (timer keeps going)
Group Discussion
• What did you do to make improvements?• Did you use one person’s idea, or collaborate?• Did you draw out a plan, or just try it?
Final Round – Same as Round 2• Must keep the same order from Round 1• Do not have to stand in a circle• Two people cannot touch the ball at the same
time• One person cannot touch 2 or 3 balls at the
same time• Must be repeatable• A dropped ball is a quality defect and you must
start over (timer keeps going)
Summary Questions
• What waste did you identify during the exercise?
• How can we apply this exercise to our jobs?• Do you think you could improve further?
Kaizen Success Story
• CompHealth Lead Response Time– VSM showed apparent bottlenecks in process– Kaizen created new process:• Reduced contact time from 64 hours to 7 minutes!
Kaizen Success Story
• Hospital in the Southwest– Billing for locum tenens was the catalyst– Opened dialogue about internal and 3rd party
payer credentialing– VSM highlighted apparent waste in existing
process– Kaizen Results:• New process created better provider experience!• Reduced internal credentialing time by 42 days!• Provides earlier access to patient care!
Where do I start?Commit Leverage
Resources VSM Choose Project Kaizen
• Commit to continuous improvement• Partner with others in your value stream• Create your VSM• Choose a beginning project• Kaizen
“It’s not what you look at that matters, it’s what you see.” Henry David Thoreau
Offer for Symposium Guests
• Onsite LEAN event• No cost• Coach you through VSM/Kaizen• Leave you with the tools to continue utilizing
LEAN methodology
Jason [email protected]