A NOTE FROM THE EDITOR
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Supply chains, Six Sigma, process control . . . these terms are part of the lexicon of manufacturing, but you don’t expect to trip over them in the context of a healthcare clinic. Think again.
At the Krannert School of Management at Purdue University (West Lafayette, IN, USA), a class project sought to find ways to improve customer service at a healthcare clinic while enabling the staff to treat more patients. “We soon realized that we could employ manufacturing principles emanating from factory physics and established industrial quality techniques to [shorten] patients’ wait times and to better utilize medical personnel,” explains professor of manufacturing management Herbert Moskowitz.
“We decided to apply factory physics at a high level,” adds operations management professor Susan Chand. “Our goals were to increase the efficiency of the clinic in terms of patient time in the office, utilization of clinic resources, quality of care, and, ultimately, revenue for the physician.”
Chand and Moskowitz contend that physician revenue has been conspicuously absent from discussions about controlling healthcare costs in the United States. In fact, many organizational healthcare arrangements limit physician revenues, and that is not conducive to making a clinic work more efficiently, they add. Healthcare can cost less than it does today, even with pay increases, when essential efficiencies are realized, maintains Chand.
“If we organize a clinic so a patient spends less time there, then we are maximizing the utilization of doctors,” says Moskowitz. “That means physicians are being more productive and giving better service, while they are generating more revenue.” The team put its theories into practice at an outpatient clinic serving low-income patients.
By mapping patient and physician flow, and identifying bottlenecks and flow improvement factors, the clinic was able to serve 37% more patients on a given day. Flush with that success, the team now is looking at ways to reduce the time between when patients call for appointments and when they are seen. Yield management is the tool it plans to use to achieve this.
“We might want to charge different prices for services booked at different times, along the lines of airlines or hotels,” says Chand. “After all, we’re [interested in] the same thing. We want to use all the seats, beds, and clinic slots, and there are established ways to manage these variables.”
The team also is considering using radio-frequency identification (RFID) tags in the clinic to more precisely track patient and doctor flow. “We’re still considering the best way to use the technology,” says doctoral candidate John Norris. “But we need the seamless collection of data that RFID technology can provide so that we can build [relevant] tools such as statistical process control charts and process capabilities.”
When I read about this project, I have to admit that I was both intrigued and a little troubled. There’s no denying that the team of students and teachers achieved a measure of success. But the exercise also raises questions.
Granted, engineering an overall reduction in the time patients spend in the waiting room deserves a standing ovation. But we all know the tinkering never stops there. Once every bit of inefficiency has been squeezed out of the front end of the operation, you just know that the time-management police will start “optimizing” the amount of time the doctor spends with the patient. And I’m not sure how the public would take to yield management techniques in a healthcare setting. It’s annoying enough to find out that the person seated next to you on a flight paid half what you did for the same ticket; who wants to be making those kinds of calculations from a gurney?
It’s no coincidence that this project originates in the United States. Americans coined the phrase time is money, and they gave the world so-called scientific management techniques for mass production, better known as Taylorism.
Using industrial methods to reengineer the healthcare paradigm is not necessarily a bad idea, as long as the MBA types remember that the patient-physician relationship also has a human dimension that resists quantification and process control.
