Doctors go ‘Lean’ to reduce wait times
3-year project teaches health-care providers how to speed up service
Family doctors in Eastern Ontario are learning the business lessons of banks and carmakers as a way to make their practices more efficient.
Nearly 30,000 patients in Eastern Ontario will see the benefits of things like “queue theory” and Toyota’s “Lean manufacturing” philosophy thanks to a three-year project aimed at cutting wait times and improving the efficiency of front-line health-care providers.
The training is being provided for free by the Champlain Local Health Integration Network, and the philosophy behind the project is simple: Helping people stay healthy longer is one of the best ways of reducing the burden on the health-care system down the road.
“I’m a numbers guy — I like the business side of medicine as well as seeing patients — and I had never heard of this and I’ve been 25 years in practice,” said Dr. Tarek Sardana, a family physician in Orléans who took part in the LHIN’s Practice Excellence program. Sardana committed a couple of hours every two weeks for a year to meet with Liz Jackson, one of three LHIN facilitators.
“We get on the treadmill and we’re running through the day and we don’t really take a step back and ask, ‘How can I make life better for everybody?’ ” Sardana said.
Front-line care providers “are dedicated and work very hard, but they’re isolated,” said Jackson, a nurse by training who became interested in how business theory can be applied in the health care field.
“A lot of them feel they’re drowning in work. That’s where we can provide support. We can pull them out of their practice for an hour or two and take a look at the forest, not just the trees, and think about, ‘What might make your work easier?’” Queue theory — the science of lineups — can help change the way appointments are booked and handled. Think of the difference between a grocery store (several checkout lines) and a bank lineup (one client line feeding several waiting tellers), for example.
The Lean management system pioneered by Toyota improves efficiency by eliminating unnecessary or duplicated work. The solution can be as simple as putting a printer in each examination room, saving the doctor a minute or two spent at each appointment walking to a central printer. Those minutes add up over the course of a day, Jackson said.
“That’s another magic bullet we have. More printers. It’s simple, but in an appointment, there’s all sorts of things like that we can do.”
At the Ottawa Public Health’s Sexual Health Clinic, for example, they looked closely at when and why patients were coming in, including enlisting the patients themselves to provide feedback. The clinic changed its staffing schedule to better deal with periods of peak demand and gave staff additional training so they could handle a wider variety of patients’ needs, said director Barb Campbell.
“We reduced the average client wait time by half,” she said. “Many clients wait 10 minutes or less between services, down from 20 minutes or more.”
The consultants can also help doctors and clinics make better use of their electronic medical records, which can be a powerful tool to manage patient care. Is a patient with chronic obstructive pulmonary disease (COPD) getting regular tests, for example, or finding the right programs to help them quit smoking? Are they on the right medications? How often should they be checked?
“COPD is an issue that’s causing a lot of hospital visits,” Jackson said. “People get out of control and they end up in Emergency. If a primary care physician can help those people so that they’re not having exacerbations, that would really have a trickle-down effect.”
While some of his colleagues have wait times for appointments of four weeks or more, Sardana tweaked his practice to meet his goal of having wait times of less than five days. Though his consultations with Jackson are done, the tools he learned help him keep his practice running smoothly.
“Definitely, my practice is more efficient,” he said. “But more importantly, I’m looking through that lens to see what’s we’re doing well. I’m done with the program, but the principles carry on.”
The $400,000 pilot project, the first of its kind in Ontario, will continue for another year.
So far, about 40 physicians, nurse practitioners and other front line care providers have taken part. More information, including how to sign up, is available at the website