In the last three weeks I've talked about cleaning out and organizing the practice storage room, implementing a 2-bin supply system for replenishing the supplies, and reorganizing the physical flow of the office. This week I'd like to talk about organizing the exam rooms. Most practices have multiple exam rooms which are in constant use as Patients are roomed, cared for and cleaned. Exam rooms can be a significant limiting constraint on Patient flow, as anyone who has waited excessively for a room to become available can tell you. Rooms are one of the main resources a Practice has, so maximizing their utilization is very important. When we look at the work flow in exam rooms, we tend to find themes:
Rooms are set up differently, with different equipment and layout. Sometimes this is personal preference for one provider, other times it is just how the layout has evolved. Many times the rooms are laid out in a legacy format, designed by people who have long since left the practice.
Signaling systems are missing or inadequate. One of the main contributing factors to delays while in the exam room is the inability of the provider to know exactly when the Nurse/MA has finished the rooming process and the Patient is available for the Provider Visit.
Equipment and Supplies are stored haphazardly with stock outs commonplace
Unless a room has a very specific purpose (and should only be used for that purpose), then there is a case to be made for standardizing room layout as much as possible. Every exam room should have the same supplies in the same place so no matter who is on duty items can be found quickly. If the gloves are on the third shelf in one room, then it should be the same in every room. This cuts down on people searching for supplies. And the same goes for equipment. Every exam room should have a blood pressure cuff instead of a shared one that has to be found every time there is a new patient being roomed. This will allow for better patient care as time will not be wasted looking for supplies and equipment. This is the beauty of standardization! Reduction in variability, easier learning curve for new employees, reduction in waste, and a baseline for improvement are just some of the benefits. Additionally, it adds discipline to the culture, and supports audits, and creates inclusion as it involves all healthcare team members.
Standardization has received a bad rap in healthcare. There is still a pervasive thought process that insists everything about Medicine is an art, and shouldn't be tampered with. To this we say - Art is appropriate in some circles, but having the platform from which to create art be consistent can allow you to create that art with fewer distractions and delays. This is the philosophy behind standardization in the medical practice. The removal of reasons to divert thought away from the Patient and how the Physician interacts with them.
Standardized work is a powerful lean tool in which the sequence of job elements have been efficiently organized and repeatedly followed by the healthcare team. Standardization can maximize quality, repeatability, safety, interoperability, and compatibility. The goal is not only consistency but continuous improvement as changes take place. Some say (wrongly) that standardization makes us all operate like robots. This is not the intent. Standardization provides the commonly agreed best practices to the entire team, and helps them all perform to that best practice consistently. From that platform of excellence, innovation is encouraged, ideas tested through PDSA cycles and deliberate changes made to continually improve the underlying processes.
Standardization is a core principle of Infinitum. We have extensive experience in designing standardized systems in medical environments. If you would be interested in holding a Standardization Workshop, please contact the Infinitum Transformation Team.