Process improvement challenge puts lean principles into practice

Posted by MEDNAX on Oct 11, 2017 3:02:07 PM
5 minute read

Our "Values in Action" series celebrates individuals and teams across all of MEDNAX who are living the Values of our company.

Empower All

We raise the bar and learn from our experiences.
We embrace autonomy while recognizing and rewarding courageous determination.
We empower ourselves and our teams to achieve individual and organizational goals.

The benefit of a team is harnessing individual strengths together to achieve success. By Empowering All, we encourage employees to draw on their unique talents, their original ideas and their independent efforts for the good of the whole, as well as their individual development.

At an annual MEDNAX Practice Managers' Meeting, empowerment became an underlying theme thanks to a hands-on simulation in lean principles. Lean improvement can apply to various fields, but the general concept is the same: deliver more without additional resources.


Learning to work lean

"The simulation activity was a wonderful session that received positive feedback and allowed the practice managers to think differently and gain essential skills to lead process improvement initiatives in their practices," said Laura Morquecho, Director of Operations and Process Improvement for Ambulatory Services. At last year's managers' meeting, a consulting group provided more in-depth training on instrumental lean tools and techniques.

Then came the challenge: The Office-Based Process Improvement Initiative. Each practice manager was asked to identify one positive modification that could be made at his or her practice, and - using lean methodology - the practice was to implement that process, focusing on a commitment to purposeful improvement.

Empowering employees means removing the fear of failure, promoting autonomy among individuals and having some fun with even a mundane task. For the operations leadership, the process improvement challenge was an opportunity to inspire empowerment through goal setting and building feedback-rich environments. "Practice managers have so much on their plates. But it doesn't have to be that way," said Morquecho. Everyone has an important role to play at a practice.


Challenge set and accepted

Each practice manager had six months to determine a process that needed to be changed, work as a team to accomplish that practice process improvement and report back on the results. The staff was encouraged to be open with each other about the processes that could benefit from improvement and have confidence in their teams' abilities. It was about finding out problems and fixing them.

In Springfield, Missouri, Renee Duff, Practice Manager for Pediatrix Cardiology of Springfield, realized this was the perfect opportunity to address an idea that had lingered at the bottom of her to-do list. "For a long time our practice thought we should do more to build our referral marketing outreach," she said.

The practice provides non-invasive pediatric cardiology care to patients in various surrounding areas of Missouri, including six clinic locations, as well as telemedicine services. But despite being accessible, the practice was often overlooked as a referral option due to limited visibility. "We knew patients were often referred to pediatric cardiology practices farther away because we were not as well known," said Duff.

The process improvement challenge became the push the practice needed. "You don't know what you don't know," she said. "We decided to find out what providers did not know about us."

The team obtained a list of physician and physician assistants throughout Missouri and then began calling the offices for contact information. "We started to dig into each little piece of this rather large puzzle and everyone at the practice took ownership of it," said Duff. No matter how little the piece, no matter a staff member's position at the practice, those small efforts soon led to one large group contribution.

By everyone, that even included the practice's provider, Frederick Emge, MD. His medical degree is not his only interest. "He's our IT guru," said Duff. "He spent hours in the databases helping us pull and sort through information. He loved it."

The team relied deeply on transparency and group feedback during their information harvest. Their initial plan was to communicate with clinical partners via email. But the team members soon realized emails were hard to find. "When you hit a road block, you find a detour," said Duff. Since the initiative began, the practice has started sending monthly faxes that raise awareness, to a list of 1,500 clinicians. "When we put it all together, we were shocked by the opportunities we have been missing all this time," said Duff. "It was really exciting to realize the long-term possibilities of this information."

At the project's inception, the team set a goal of increasing monthly volume by 5 percent, which was a standard caseload growth goal. To date, the practice has seen a 10 percent monthly increase in practice cases and more than a 10 percent increase in telemedicine requests.


The bigger picture

The increase of business without additional resources is the goal of lean principles. But for the operations leadership, and the practices themselves, there was a second advantage to this effort: raising the bar and learning from experiences, which is at the heart of empowerment.

"It breaks the silos of work and changes culture," said Morquecho. "It's a new way of thinking. We hire a practice manager to run a practice, but the practice is a team," she said.

Duff agrees. "At first, our staff viewed the process improvement project as a task because it was broken down so much. It became something to fill downtime, and it could be a bit tedious," said Duff. "But as the project came together and the staff saw how their individual efforts were building something greater, the excitement definitely grew," she said. "And we're not even done."

"Your subject experts are right there in your practice, so engage them," said Morquecho. "Improvement is not just about the practice manager doing the work. It's about a whole team coming together to set goals and solve problems."
In addition to Pediatrix Cardiology of Springfield, more than 50 practices completed unique lean process initiatives, including:
  • streamlining Medicaid authorization processes
  • decreasing patient wait times and front office patient flows
  • increasing monthly percentages collected for service payments
  • improving scheduling templates
  • streamlining processes to interpret outpatient scans or track, confirm and relay test and lab results

MEDNAX has more than 175 office-based practices across the country, providing services across the continuum of care.