Posted by: Knightbird | June 11, 2011

Quantifiable Results

With simple math, and using the results achieved by healthcare organizations that use Lean thinking, it is easy to quantify the results of a new way for managing healthcare.

Chugachmiut manages a health care system. We see patients when they have complaints.  I have argued that using Lean healthcare can improve patient throughput by as much as 30%. A provider who sees 20 patients a day can see 6 more patients a day. At the Virginia Mason Kirkland Clinic, one provider increased to 30 patients from 20. This has a profound implication for patients and the cost of their care. I put together a spread sheet that shows a 30 percent increase in throughput reduces the number of providers used by about 23 percent.It reduces the number of exam rooms needed by approximately the same percentage. The same is true of support staff. They become more productive at the same time patient revenue is increasing by about the same amount-23%. Lean healthcare is worth the work and investment.

What many people don’t know about patient visits is that up to 80% of patient visits do not have a readily explainable organic reason for the patient complaint. The complaints are real, but the physical reason for the visit isn’t discoverable. Dr. Vincent Fellitti, Co-PI for the Adverse Childhood Experience Study, told our tribal members at their April 6-8, 2011 Restoration to Health Consultation that, after they discussed the issue of unresolved childhood trauma with the patient, patient visits declined by about a third. Can you imagine the implications of lean and behavioral health interventions working together. A third fewer visits combined with a 30% improvement in patient throughput lowers the number of providers needed by about 45 percent. Combined with the reduction in exam rooms needed and the use of support staff, our health care costs decline substantially.

I have argued that we have plenty of health care resources in this county, but we just don’t utilize them appropriately. And I have said nothing about the incredible quality improvements to be gained through Lean. The Indian Health Service talks about inadequate resources all the time. I laid this strategy out for them, and received a thank you for your letter and we will get back to you soon response only after I cornered one of their executives and mentioned that I had not even received an acknowledgement for my ideas.


  1. I think one of the things to keep in mind with lean is that seeing more patients doesn’t mean racing through appointments and giving patients sub-standard care. I think most people equate “more throughput” with going faster and they assume going faster harms quality. But when we work to reduce waste, everything flows better – patients wait less and get better care and doctors don’t waste as much time and get to see more patients. It’s hard sometimes to understand this until you see it in action!

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