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

Lean Cycle

Perfection

Specify Value

Map Value

Stream

Create Flow

Pull

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?

Lean Cycle

Perfection

Specify Value

Map Value

Stream

Create Flow

Pull

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

Recruiting Value Stream Map

Hire Providers

Providers Deliver

Healthcare

Physician Recruiting Value Stream

Provider

Provider

Provider

Provider

Value Stream – Provider PerspectiveRe

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Value Stream – Departmental Perspective

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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

Lean Cycle

Perfection

Specify Value

Map Value

Stream

Create Flow

Pull

Monkey Story

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)

Eliminating Waste

Exercise

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)

Begin Round 1!

30 Seconds to Plan

Round 1 Results

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)

Round 2 ResultsBegin Round 2!

1 Minute to Plan

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)

Round 3 Results

1 Minute to Plan

Begin Round 3

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 Calljason.call@comphealth.com801.930.3182

Questions?