This presentation illustrates the movement from a "push" process in a doctor's office to a "pull" process, which reduces WIP and other forms of waste.

1. presents:
Stop “pushing” your patients around
Implementing “pull” in your medical practice
workflowdiagnostics.com
1-855-FLOWDOC

2. “WIP” – Excessive Work-in-Process
• Created by “push”
• Creates waste –
waiting, overutilization, overprocessing
• There is no limit to WIP – other than the number
of exam rooms, waiting room chairs, etc.
• Requires energy and space to manage
• Excess inventory indicates excess capacity
• Consider: Where is / are the constraint(s) in the system?
• Typically: The “examination” process, i.e. the MD

3. “Push” & WIP Explosion
Here’s what’s happening now: Pat Pat Pat Pat
Pat Click once for each patient
Pre-Physician Physician
Process “PUSH” PATIENTS Process
-Arrive / Sign-in -Exam
-Registration -Interpretation
-Check-in -Notes
Waiting Room Exam Rooms
• Complete work and “push” patient to next step
• Empty rooms must be filled
• Temptation to truncate work on each patient (e.g. note)
• WIP requires constant attention and energy to monitor,
not to mention space to accommodate
• Wait time spread throughout the system
• Up-and-down, stop-and-start

4. “Pull” & WIP Cap
Here’s what could be happening: Pat Pat Pat Pat
*Isolates all waiting Pat MD “PULLS” NEXT PATIENT (1) INTO CHECK-IN PROCESS
to waiting room,
where it can be seen
& lopped off Click one time only MD
Exam Room 1
-Exam
-Interpretation
Pre-Physician -Notes
Process
-Check-in
-PFT or CXR
Exam Room 2
-Exam
-Interpretation
-Notes
• Patients are “pulled” through the process by MD
– e.g. MD entering room triggers next check-in
• MD (constraint) sets rate of production (Takt time)
• Characterized by level flow & one-piece flow EXIT
– Physician completes one patient and previews next
while check-in & procedure are performed
– 2-cylinder engine

5. Benefits
• Reduced WIP and the energy & resources to manage
– Fewer rooms needed
– Less travel; more order
– Better resource availability
– Less waste
• Clarity & simplicity – Who’s next, where to go,
who’s waiting, where are they, etc.
• Rhythm & flow
• Lower cycle times
• All the work finished, every day

6. Strategy
• Need 5 things:
1. Constraints management – find the bottleneck(s)
and do everything possible to help him/her move
more quickly
2. Visual workplace – cues, indicators, shared metrics
3. Standardization coming into & out of exam room
4. One-piece flow mindset
5. Identify level flow, e.g. Non-physician vs. physician
processes – Implement trigger for work upstream
• WIP cap, e.g. authorization card w/ doc’s name
Pilot with one MD’s simplest, most routine patient set

7. Contact
us:
WorkflowDiagnostics.com
1-855-FLOWDOC
Twitter: @workflowdx
Thank You!
All stock images courtesy of http://office.microsoft.com