Posted by: knightbird | July 7, 2010

The Snoopy Dance

One of my fondest memories during the start of our Lean Healthcare journey happened in our regional clinic in Seward, Alaska. Seward is a special place. My father went to a boarding school there as a boy. My Uncle was in an orphanage in Seward. Some of my favorite people have lived there. A coastal village located on Resurrection Bay, Seward hosts thousands of people in July for their Salmon Derby, 4th of July events and the Mount Marathon Run. Our clinic serves over 500 tribal members living there.

We were conducting a Kaizen Blitz in the downstairs empty space where we now have our exercise room. Our Lean Consultant, Tom Jackson, was facilitating 4 groups working on different value streams. The value stream my group was to work on came down to a decision between 2 important ones, Contract Health and Billing & Coding. The 2 employees who managed the value streams argued over whose value stream was going to be mapped, and Contract Health won. The Billing & Coding value stream was the one we mapped. (In case you didn’t catch my attempt at humor, neither employee wanted their value streams mapped so the winner was the one who didn’t have to map). On Tuesday we mapped the current state, defined a future state, and did an affinity diagram with improvement ideas. Two of the improvement ideas offered by the owner of the value stream included “faster fingers” and “no vacations.” She also asked for 2 new employees to assist her. We laughed, but I think she really meant it.

The results of the mapping were immediate. The entire value stream took 90 + days to complete, and the major reason was the amount of batching we did. Batching is a huge enemy because it fosters so much waste. Our Village Clinics batched their Patient Encounter Forms and Superbills for a month. Our Seward Clinic batched for a week. This meant that our B&C Staff were constantly racing to enter data. It took about 2 weeks to enter the Village Clinic Data and the better part of a week for Seward. The process involved a lot of phone calls back and forth to correct defective forms.

The future state we discussed involved and Electronic Health Record, and essentially required about 5 minutes to complete, quality check and have ready for billing. However, an EHR was not immediate so we improved by reducing batching to one week. The improvements were immediate. We have continued to work on our future state, and one great result has been about a doubling of revenue. We also outsourced the B&C because the position that managed it became vacant, and it was far less than a full time position after the improvements.

And the Snoopy Dance? When we asked the employee what she thought of the Kaizen, she didn’t say a word. Instead, she got out of her chair, walked into view of the other participants, put her finger on her head, and did a little dance. Thus was born the story of the Snoopy Dance. She loved the control Kaizen returned to her.

And the Contract Health employee? After we mapped the B&C value stream, she came back to the meeting on Wednesday with a big pout. When I asked her what was wrong, she said she wanted her value stream mapped. So we did.

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