The Lean Practice Coach

This morning had the privilege of taking my daughter to the oral surgeon to have her wisdom teeth removed. The intake process was pleasant enough, she went to the operatory, and I settled into the waiting room while the surgery was taking place. I opened my computer to work, and looked for a Wi-Fi connection. The office had wireless, but it required a security key to access. I went to the front desk to ask if wireless was available. The FD person looked up after a minute, said “no” and looked back down at her paperwork.

I found the interaction unsatisfactory.

On the one hand, I understand if the practice doesn’t want to offer Wi-Fi. On the other hand, the FD person could have been more sociable. The oral surgeon has a practice where return customers/patients are less important than at most practices, so maybe it doesn’t matter. If my daughter’s primary dentist asks “how was the experience at the oral surgeon’s office?”, the answer will not be as positive as it might have been.

The questions I would ask this oral surgeon include:

1. What is your standard for customer interaction?
2. Is the person who sits in the waiting room, and pays the bill a customer?
3. Have you thought about the customer experience of those who wait? (beyond the radio playing and magazines)

Customer Satisfaction is Lean Principle #5. In this and the next post we will explore customer satisfaction, and what it means to you and your practice.

First, what is a customer to your practice?

• Are customers the patients that walk in the door?
• Are customers those who receive services from the practice?
• How about you? Are you a customer of the practice?
• How about your staff? Are they customers of the practice?

I would use Webster’s definition as a logical starting point: 1) a person who buys, especially on a regular basis; 2) a person with whom one must deal. The U.S. GAO defines customer as groups or individuals who have a business relationship with the organization–those who receive and use or are directly affected by the products and services of the organization. Customers include direct recipients of products and services, internal customers who produce services and products for final recipients, and other organizations and entities that interact with an organization to produce products and services

Are patients the only customers of the practice? No, the dentists and staff are also customers of the practice. So are specialists, such as oral surgeons and so forth. I’m sure that your practice has many customers other than patients. A practice will have a number of customer types such as types of patients, types of staff (less position than temperament/motivation), types of specialists, and so forth.

What kind of customers do you want?

• Rich and famous?
• Elderly?
• Pediatric?
• Families?
• Industrial?
• Cosmetic?
• Restorative?
• Pleasant and competent coworkers?
• Entrepreneurial/self-motivated or “employee”?

As you have already noticed, we can’t begin to talk about customer satisfaction until we know who are customers are. Until we understand who the customers are by type, we cannot design processes to satisfy them. Another way to look at this is until we understand what kind of customers we want, we can’t design processes to attract and satisfy them.

Lean Principle #5 is Customer Satisfaction. There are a number of questions that could be asked about customer satisfaction; What is customer satisfaction? How do we measure it? How do we improve it? and etc. All of the other Lean Principles serve the principle (and goal) of Customer Satisfaction. We define the various dimensions of customer satisfaction as in the following table:

What are your goals for the patient experience? How do those goals translate into measureable outcomes for your practice? Should you have a set of standard practices for… greeting patients? …for seating patients? …for taking payment? …for taking x-rays? … for answering the phone? and etc.

Lean Principle Number 4. The visual workplace.

The visual workplace has signs, labels, color-coded markings, workplace arrangement and etc. so that anyone can see what is going on (or not) at a glance. For this example of the visual workplace we will use collections. This example comes from a recent visit to a client’s office where they have developed this system to suit them. They are particularly proud of their results. Let’s see what they do.

In the picture above, you can see the heart of their collections system, the “rack”. This shelving unit has dividers for each day of the month, as well as several additional dividers that can be used for storage. They have labeled divisions for each day, as can be seen in the picture below. You can see the labels have both a number and letter. The users of this system said that they do not use the letters. It is more convenient to use the numbers for dates, rather than letters for names, because many of the collections activities are date sensitive.

You have noticed that there are different colored folders. The colors are at the heart of this visual workplace. In the picture below you can see the poster with the color codes for the folders. Yellow folders are used to collect information, phone call records and notes before proceeding to small claims court, if need be. The materials are moved to a purple folder when the decision is made to pursue collection via small claims court. Green folders are used when the collections case has either been rendered for collection via wage garnishment or if the responsible party has agreed to regular payments. Blue folders are used for income tax garnishments. Finally red folders are used for accounts that are dead, i.e. bankruptcy, moved out of state, etc.

Below you can see the storage area for purple folders. Most of them are used, waiting for the next case. The users of this system report that when they started it up (taking over from a less than diligent clerk), the predominant color was purple which means that not much was scheduled for collection and lots of court time was in order. As you can see from the first picture, the predominant color now is green, which means that collections are scheduled. The point of the visual workplace is that you can see the “state” of the process at a glance. Here green is good. The Doctor can also see the volume of collection cases at a glance.

The files are put into the divider for the day designated for follow-up which could be a phone call or payment or etc.

Below, Leilani wants to remind you that the 30 seconds required to make the note, can save 3 or 30 minutes required to reconstruct the conversation or to determine what to do next.

Both the dentist and the office manager have been surprised and thrilled with the ease with which the new process can be managed, and more importantly, how much AR has decreased since the implementation of this example of the Visual Workplace.