Business & Practice

LEADERSHIP 101

Process: Lean Six Sigma Principles

By Jay Greenstein, DC

In this article, we discuss the fourth element of the Entrepreneurial Operating System (EOS): process (within the Leadership Series of articles that began in the July 2012 ACA News, p. 24). Remember, the six major categories of discussion are:
1. Vision see Aug. 2012 ACA News, p. 32. 2. People see Sept. 2012 ACA News, p. 30, Oct. ACA News, p. 28 and Nov. ACA News, p.32. 3. Data see the Dec. 2012 ACA News, p. 30. 4. Process 5. Issues 6. Traction Lets face it: Process discussions are typically not fun. Who really wants to have a staff meeting and discuss process? Even worse, who really wants to map out your key processes to ensure that they are done correctly? Ill tell you who: the leaders who run great practices. ey do it, not because they want to, but because they realize they have to. Gino Wickman, founder of EOS and author of the best-selling business book, Traction, states: Nothing can be ne-tuned until its rst consistent. e Process Component is strengthened through your understanding of the handful of core processes (on average, about seven) that make up your unique business model. You then have to make sure that everyone in your organization understands them, values them and follows them. is component is the most neglected one, often taken for granted and undervalued by entrepreneurs and leaders. Yet, the successful ones see what process can do for them. By not giving this component your full attention, its costing you money, time, efciency, and control. 1 So where do you begin? 1. Employee training process 2. New patient intake process 3. New patient visit process 4. Existing patient visit process 5. Re-exam visit process 6. Patient discharge process 7. Billing and collections process 8. Referral source marketing process 9. Internal referral process 10. Patient reactivation process

STEP TWO. You and your staff build

macro maps of the ve to seven key processes in your practice. Below is an example of a new patient intake process for a practice. So break out the whiteboard and document your key processes that manage 80 percent of the work!

STEP THREE. Now, its time to review the processes for efciency. Many practices, including ours, have redundant or inefcient processes. e reasons for this problem are varied. In our practices, we created redundancy to ensure that our data entry is correct. We are always in the process of improving and leaning out our key processes. is really is the next critical step in process improvement. Lean is a production practice that considers the expenditure of resources for any goal other than the creation of value for the end customer to be wasteful, and thus is a target for elimination. Working from the perspective of the customer who consumes a product or service, value is dened as

PER collects and inputs info into VOS

Patient Info - collect name, DOB, telephone number, address, email

QI - collect ins info - name, mem ID, group #; collect primary info - name, DOB; collect who referred by PI/PIP/WC - collect carrier name; policy number; adjuster; lawyer

PER schedules appointment

New Patient Intake Process

Sends conrmation email to patient VOB PendingPIC review Pt. Acct Info Complete? YES/NO

PER CREATE TASK (requesting VOB)

PER sends task to PIC requesting VOB

PIC contacts insurance provider to verify benet Find info? Yes or No Call insurance provider Search insurance website PIC tries to retrieve missing info by: Contacting patient Searching ins. websites

STEP ONE. You sit down with your staff

and decide on the 20 percent of the processes that do 80 percent of the work in your practice. ats typically about ve to seven processes. So what might that look like? Ive listed some examples:
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BCBS

UHC

Inform PER that VOB is incomplete and state steps taken to acquire info

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any action or process that a customer would be willing to pay for. Essentially, lean is centered on preserving value with less work. This is typically done in conjunction with a synergistic methodology of Six Sigma. Six Sigma is a process improvement set of tools and strategies that seek to improve the quality of process outputs by identifying and removing the causes of defects (errors) and minimizing variability in manufacturing and business processes. Below are some of the key areas of focus for both methodologies.

might not be willing to pay for it, but its an essential step in the process for your practice. The idea behind lean is efficiency, so dont get too caught up in the definition of value if you find its impairing your ability to make decisions and move forward. For those of you who dont have: (1) your process documented, and (2) your team welltrained on them, even just doing the first two steps is going to have a huge impact on your practice.

Step Four. Do your best to remove inefficiencies, and then, as the last step states above, train your staff. Step Five. Process Improvement Part II. After working with your new process for 90 days, hold a follow-up meeting with your staff about the next level of process improvement. Every practice has business challenges, so one of the best ways to address those challenges and implement long-lasting solutions is to use Six Sigma. Six Sigma follows the DMAIC methodology:
Define the Problem Measure the Problem Analyze the Problem Improve the Problem Control the Solution to the Problem

rant would no longer be your favorite! Whether making food, pagers or health care outcomes and experiences, variation in process is evil. So, Motorola needed a quick solution. Leadership and engineers implemented Six Sigma, and to say the results were staggering is an understatement. Six Sigma processes resulted in $16 billion to $17 billion in savings to Motorola as of 2006! This can work for your practice as well. When dealing with a practice issue, following the DMAIC methodology can have tremendous impact on your practices quality.

Lean
Guiding principles-based operation system Relentless elimination of all waste Creation of process flow and demand pull Resource optimization Simple and visual

Define the Key Problem in Your Practice

Strength: Efficiency Six Sigma

Focus on voice of the customer Data- and fact-based decision making Variation reduction to near perfection levels Analytical and statistical rigor

Measure the Current Result You are Getting

Analyze ALL the Potential Causes of the Problem

Strength: Effectiveness
When it comes to process improvement, both Lean and Six Sigma are important; therefore you may hear the term Lean Six Sigma used often. So for fun, lets process-map this out.
Meet with Staff to Identify 5-7 Key Practice Processes

Improve the Results Using Statistical Analysis and Comparison to the Original Benchmarked Data in Measure Phase

Control the Three to Five Key Variables in the Process to Guarantee the Desired Results

Document Each Step in the Process

Identify Any Process Step That Does Not Add Value Or is Wasteful and Remove It

Ensure That Staff is Fully Trained On Each Process Step and Can Execute the Steps

Remember, value means something that the customer is willing to pay for. You have to keep in mind that you have both internal (e.g., fellow staff members) and external (e.g., patients, referral sources etc.) customers. There may be exceptions where the customer
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The idea behind Six Sigma is that in any given business process, there are three to five key steps in that process that must be controlled to get the desired result. This methodology came about because of the business problems at Motorola. Back in the 1980s, Motorola was manufacturing pagers. Because of manufacturing process flaws, many of the pagers that came off the assembly line didnt work properly. Why? There was variation in the manufacturing process that caused defects in the final product. Defects cost money. They cost money to fix, but even more important, they also reduce customer loyalty. Picture yourself as a consumer. When you go to your favorite restaurant and order your favorite dish, you want the same great meal every time. If there was variation each time, that restau-

Lean Six Sigma requires an investment: an investment in time and an investment in learning. The DMAIC process revolves around data (see ACA News, Dec. 2012, p. 30), so it will take time to learn, collect and analyze the necessary data and make continuous improvements. That being said, the investment is well worth it, because the return on investment is a consistent and improved practice. The good news is that there is lots of information on Lean Six Sigmabooks, audio CDs and even free online learning! As a member of the ACA, I will provide this information to you. All you need to do is contact me at drjay@kaizenconsult.com.
References 1. Wickman, Gino (2012-04-03). Traction: Get a Grip on Your Business (Kindle Locations 22762280). Perseus Books Group. Kindle Edition.

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