Health care management is increasingly complex during the COVID-19 pandemic with many challenges expected to remain as it subsides—in particular, increased inbox volumes as virtual care expands with burnout also on the rise.
External pressures in the market and industry pile on as internal compulsions for productivity and time management amass at a fever pitch; despite promises for efficiency, electronic heath record (EHR) tools can add to administrative burden. Burnout is at epidemic rates, and however well-intentioned, wellness initiatives often manage symptoms but leave root causes untreated.
Fortunately, lean methodologies can help providers in ambulatory practice regain control of days, complete work, and return home on time—while still delivering excellent care and a sense of professional satisfaction.
Transform Your Practice Through Daily Habits
Take a targeted approach to transform how you practice ambulatory care by moving away from the behaviors of batch and into flow.
Batch production is when tasks pile up; flow references the act of tackling tasks in small manageable lots throughout the day.
This transition involves thinking of care delivery in an entirely new way: not in terms of provider-patient transactions but instead in terms of a flow cell—an arrangement of team members, time, technology, supplies, and treatments that work together to produce service and care without waiting between handoffs.
What Can You Expect When Moving from Batch to Flow?
Moving from batch to flow can help remove waste from your practice—which can ultimately help free up time for things that matter most in medicine: improved quality and care and healthy providers who can sustain a fulfilling practice.
It’s not about working more or harder; it’s about reclaiming tasks, processes, and time so your team functions efficiently at its highest level.
Potential benefits from moving from batch to flow can include:
- A day that involves teamwork with a trusted and well-trained dyad partner in each medical assistant (MA)
- Smooth transitions between patients
- A clear inbox with tasks clearly assigned
- In-person and virtual visits set up in advance
- Clear and concise notes and documentation written and closed efficiently
- Steady pace of work throughout the day that doesn’t feel increasingly rushed or depleted as the afternoon descends
- The ability to go home on time and not take work home for evening catch-up
For example, consider Dr. B and Dr. F who were medical group colleagues.
Dr. B had an average of 65 items left in her inbox every day, so she caught up in the evening between stints of helping her children with homework. She resolved some notes before coming home but many remained, which she handled after her kids were put to bed. The next morning, before her visits, she completed another 10 inbox items, which got her off to a late start. Throughout the day, her inbox piled up once again.
Dr. F, however, committed to moving from batch to flow. At the end of each nine-hour workday, she only had three unfinished phone tag items in her inbox—and these were because she wanted to reach out to patients directly.
The following morning before her first visit, she huddled with her MA for 15 minutes, set agenda targets, signed protocol orders, built problem lists that loaded into notes, and set up shared decision-making tools.
Together, she and her MA signed Family and Medical Leave Act (FMLA) forms and reported a few labs before diving into the first visit. Between easy and complex patients, Dr. F’s medical assistant set up two to three inbox items; together, they used three inbox pauses per day to keep apace of the normal 50-70 items per day.
They also reduced the documentation time for moderately complex visits—coded as 99214 with detailed history, detailed exam, and moderately complex decision-making—by using voice recognition and concentrating on decision making text in the assessment, each done in three to four minutes.
A friend had also shown her that notes composed hours after a visit—in batch—were 15%-30% longer without improved quality of content.
How Are Lean Strategies Used for Improvement?
These five lean strategies can help you implement a transition from batch to flow.
1. Adapt a “Don’t Just Work; Stand There” Mindset
Lean teaches critical thinking and problems solving so that you slow down to speed up.
By pausing and reconsidering the way you work, you can eventually transition to a state where you can do the work that matters.
Critical thinking and root cause analysis can enable you to consider deeply the flaws and defects in your current processes and imagine how to improve them.
2. Go to Gemba
Gemba is the shop or practice floor, the place where the actual work is done. Going to the gemba to see operations firsthand is always a priority in lean methodologies.
Watch each step of the care process objectively to see how it relates to the next. Observe areas of value and efficiency, as well as waste and defects.
3. Create Value Stream Maps
Once you visit the gemba, you’re ready to map your care process. Draw out every step, then time each one and the spaces in between.
Afterward, imagine your ideal future state—and map what that would look like. Conducting a gap analysis will then help you determine what you need to do to move from your current to future state.
4. Conduct Improvement Events
Once you articulate problems, create countermeasures and test solutions.
Set metrics for success. Perform small experiments to find the best solutions.
5. Write Standard Work
Document those effective practices so you can operationalize your new solutions.
Keep improving and make those your new practices.
What Options Are Available to Fast-Track Solutions?
Lean is an improvement methodology that can help every aspect of your work—and can guide you as you move from batch to flow.
Transitioning these specific challenges from batch to flow can help fast-track solutions.
1. Create Provider-MA Dyads That Include Colocation and Huddles
Establishing a shoulder-to-shoulder dyad can help enhance workspace and collaboration, leveling the load of work.
The MA effectively becomes the provider’s flow manager throughout the day, a relationship that depends on trust and training. With proper precautions, this can still be achieved successfully during the COVID-19 pandemic.
In huddles, the provider-MA dyads:
- Go down the schedule list to add items
- Select visit note templates
- Set up orders to complete tasks
- Prepare for contingencies
The dyad helps ensure that visit work is assigned to the right care team member and makes time and space to complete non-visit work as well.
2. External Setup
Collaborate with your MA to conduct prep for standard parts of the day—huddles, rooming, face-to-face and virtual visits, and between-visit work.