Dermatology clinic finds waste opportunities with gemba walk observations
A dermatology clinic was curious if waste and opportunity could be found in their small clinic in Texas. They asked me to come down to perform a gemba assessment for 1.5 days. Before I arrived, I made notes about my experience finding the clinic, parking, and navigating to the office. I met with the dermatologist who ran the clinic, along with the team members at the beginning of the day, about one hour before the clinic opened. I set up my “Ohno Circle” where I could observe patients entering the clinic, being guided to the office rooms and paying their bill. I was given the patient schedule, and I tracked patient arrival time, patient time into room, and patient departure time. I did not go into the office rooms, I simply watched and studied the flow of patients through the clinic.
I noted some best practices and good processes they were already doing, but I also provided them with some of my observations and recommended actions. Some of the key findings were grouped into process areas and roles:
Front Office
- Patients often arrive late due to parking and traffic
- New patients are not getting email of forms and documents, which delays their first visit
- Color code folders based on new patients, checkup, medical assistant work, review, etc
- Patients do not want to reschedule next appointment when checking out, but no follow up is done
- Customer satisfaction not being tracked, anecdotal evidence only
- New patients require copying of multiple forms
- Patients are canceling same-day or not showing up, consider testing a charge fee (maybe waive it for first violation)
- Lack of feedback to staff on how they’re doing (no metrics or data)
- Patients must re-write all their information each year, consider printing out their current info and asking what has changed
- Customers express frustration in waiting room, not given any estimated wait times
- Gendar categories on form are only binary (male/female) and questions don’t match in system
Medical Assistant
- Not easy to know if patient is waiting too long in waiting room
- Most processes are performed by memory, no standards documented
- Potential safety risks for people walking around corner, maybe add some mirrors
- Supply kitting area is congested with too much clutter, suggest 5S event
- Patients placed in far back office rooms requiring more walk time for dermatologist and staff
- Supplies run out for rare and infrequent procedures, suggest a kanban system
Electronic Medical System
- Face sheets need to be printed twice, see if it can be combined to only have to print once
- Move state field near top of page and make default selection “Texas”
- Multiple clicks needed to check schedule availability
Building/Office
- Improve signage to make it easier for customers to find office from parking lot and within courtyard
General
- Use Friday afternoons to discuss and work on improvements instead of seeing more clients
I met one-on-one with each staff member to get more insights on their role, and what opportunities they saw in their own work. I also provided them with some data analysis of the process times, to give them an idea how long it takes to perform certain tasks. This helped them prioritize where to focus on for improvement.
After presenting the recommendations to the team, they took the report, reviewed it, asked for clarification, and then decided which ones were easy to implement or test out. Unfortunately, I was unable to budget time for me to go back and follow-up and measure the impact of these changes, but I know there were 3 or 4 of these that they did implement.
A summary of the project was published in SKIN magazine (May 2024)
