Applying the Theory of Constraints to Ambulatory Practice

1. Applying theTheory of Constraintsto Ambulatory Practice

2. Where we are today in family medicine. How did we get here? Where would we like to be in family medicine? What changes can we make to go from where we are to where we want to be? Family Medicine

3. Family Medicine

4. Where are we today? 60% of PCP�s would leave primary care if they could. The number of US medical students choosing primary care has declined 10 years in a row � totaling a 50% drop. 27% of PCP�s report symptoms of being burnt-out. 50% of PCP�s describe their office as �chaotic.� �We�re working harder and harder, but not earning an increasing level of income.� � Medical Economics 12/2007 �How do we leverage our data and quality and get...Medicare not to make pay cuts that are going to all but destroy primary care.� � Medical Economics 12/2007 �Crisis in Health Care� � Medical Economics 12/2006 Conclusion: Point A is not looking too good�

5. Family Medicine

6. How did we get here?

7. Family Medicine

8. Where would we like to be in family medicine? Evidence-based, quality care High patient satisfaction High staff satisfaction Comparable salary and work week Sufficient free time

9. Family Medicine

10. Life is short, and Art long; the crisis fleeting; experience perilous, and decision difficult. Hippocrates 400B.C.

11. Baby Boomers are Aging 34 Million > 65 years old in 2007 70 Million > 65 years old in 2030

14. More Patients, Less Doctors

15. WE ARE BOOMERS TOO !Numbers of Physicians over 55

16. More and Older Patients Higher Disease Burden Higher Expectations both Patient and Regulatory Short Run Fewer and Older Physicians In Summary

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18. Paradigm Shift Care will be delivered in different ways than it has been done for the last 100 years.

19. What changes can we make?

20. Availability Efficiency Competency Convenience

21. �Financial success without quality is irrelevant and quality success without financial is unsustainable. They are inextricably linked.� -Mark Werner, M.D. CMO, Carilion Health System 2005

22. Where are the constraints in our current system? Can we use the Theory of Constraints to exploit those constraints?

23. Theory of Constraints A management philosophy developed by Dr. Eliyahu Goldratt Geared to help organizations continually achieve their goals through application of a set of basic principles, processes, and logic tools

24. Theory of Constraints �The Goal� � 1984 Five focusing steps Manufacturing Project management Supply Chain / Distribution Thinking processes Marketing / Sales Finance

25. Before the 5 focusing steps of TOC: What is the goal of the organization?

26. What is the goal of a medical practice? To make money To deliver high quality (�Financial success without quality is irrelevant and quality success without financial is unsustainable.�)

28. Five Focusing Steps ofTheory of Constraints Identify the system constraint Decide how to exploit the constraint Subordinate everything to the constraint Elevate the constraint Return to step one, but beware of inertia

29. Identify the system constraint Where is the constraint in your practice? Is it in the right place? Is the physician the constraint?

30. Example: Suppose the front office is the constraint� The constraint has been identified, so Decide how to exploit the constraint Subordinate everything to the constraint Elevate the constraint Return to step one, but beware of inertia

31. Example: Office morale is the constraint The constraint has been identified, so Decide how to exploit the constraint Subordinate everything to the constraint Elevate the constraint Return to step one, but beware of inertia

32. The physician is the constraint. Now what? How do we exploit, subordinate everything to, and elevate the physician? By relieving him/her of all duties that someone else in the practice can perform.

33. Family Team Care: Application of TOC to Medical Practice Family Team Care works because it exploits, subordinates practice resources to, and elevates the performance of the physician.

34. Family Team Care

35. The core of this innovation is an assistant who is capable of taking and documenting a complete and competent patient history for the visit.

36. Remove the physician from the most time consuming part of the visit. Allow the physician to focus on only the aspects of the visit that require his/her expertise. Therefore, hopefully, more patients could be seen without sacrificing quality of care or patient satisfaction.

37. RN, LPN, or MA Dependable Trustworthy Skill Capability Personable

38. Quality of care has dramatically improved Results of Family Team Care

39. More time to ask questions More time focused on medical issues Improved accuracy of charts Improved documentation Increased availability Improved Quality of Care

42. Anderson HSRP 2002-2007

43. Quality of care has dramatically improved Patient Satisfaction has improved Results of Family Team Care

46. Quality of care has dramatically improved Patient Satisfaction has improved Financial Performance has improved Results of Family Team Care

48. Quality of care has dramatically improved Patient Satisfaction has improved Financial Performance has improved Staff Satisfaction has improved Results of Family Team Care

50. Quality of care has dramatically improved Patient Satisfaction has improved Financial Performance has improved Staff Satisfaction has improved Professional Satisfaction has returned Results of Family Team Care

51. Transition

52. A decision to change Communication to others of the need to change Development of incremental, modest changes that lead to the final goal Principles of Change

53. PART 1 - Data gathering and communication of the data. physician or assistant PART 2 - Analysis of data and pertinent physical exam. physician only PART 3 - Decision-making and development of a plan. physician only PART 4 - Implementation of the plan and patient education. physician or assistant The Patient Visit: 4 Parts

58. Read pages 2-15 in the manual, �Liberating the Family Physician� Watch both DVD�s in their entirety Requires about 2 hours of time Education of the Physician

59. Thank you for your interest in TOC and Family Team Care Peter B. Anderson, MD Medical Director, Riverside Hilton Family Practice familyteamcare@gmail.com Charles O. Frazier, MD, FAAFP, CPHIMS Vice President, Clinical Innovation, Riverside Health System charles.frazier@rivhs.com