Applying Lean P rinciples to the Provider Recruiting V alue S tream

1. Applying Lean Principles to the Provider Recruiting Value Stream

2. Multi-Specialty Group in the Southeast Asked us to participate in vendor management system • Further discussions uncovered: • Undefined process • Desire to save $ • Desire to “do it better” • Introduced client to Lean which resulted in: • Reduced fill time by 22%! • Eliminated 24 steps in process! • $2.5 Million in additional revenue/year!

3. What if you could… • Reduce the amount of time it takes you to respond to potential candidates from 64 hours to 7 minutes • Take back or free up 20% of your work week • Reduce your credentialing and 3rd party payer processing times from 84+ days to 42 days • Reduce the average time to fill an open position by 32 days

4. What is Lean? • A methodology to improve operations through: • Relentless attention to detail (quality) • Commitment to data-driven experimentation • Empowering employees to eliminate waste in their jobs

5. Lean Cycle

6. Specify Value • What actions do I perform that provide value to my customer (from their perspective)? • Would my customer be willing to pay for the time/materials associated with each action in my current process?

7. Lean Cycle

8. Value Stream • A value stream is the set of all the specific actions required to create and deliver a product or service (or a combination of the two) to your customer. • In our case – What actions do you perform in order to ensure that your patient population has access to medical care when needed? • Identify the entire value stream for a given deliverable. • Allows you to begin to uncover and eliminate waste in your workflow. • If it can be measured…

9. Value Stream Map • Low tech approach – doesn’t need to be glamorous • Always by hand, in pencil • Walk the flow • Flow of materials • Flow of information

10. Create a VSM – Morning Routine • Draw a box for each step of your morning routine • Connect the boxes with arrows, in the order you perform each step • Indicate time spent for each step • Indicate time spent waiting between steps • Indicate if each step provides value • Create a table that totals the results Facial Hair? No Shower 9 min Yes 0-15 Shave 3 min

11. Morning Routine VSM (Current State) 6:20 Alarm Snooze 6:25 Alarm Snooze 6:30 Alarm 5 min 5 min Facial Hair? No Lay in bed Check Email Get out of bed Shower 5-10 min 5 min .5 min 9 min Yes Late? No Shave Teeth Hair Clothes 6 min 3 min .5 min Yes 2 min Yes Breakfast Drive to Carpool Drive to Work Arrive at work 5 min 4 min No 30-40 min 0-15 Hungry?

12. VSM • Based on current state: • Are there obvious actions that can be eliminated? • Can items be rearranged or integrated into others to create efficiency? • What waste can I identify in the process? • Are there areas in the process that are necessary, but can be changed to become more efficient? • Create a Future State VSM

13. Future State VSM 7:00 Alarm Get out of bed Teeth Shower Hair .5 min .5 min 2 min 5 min Clothes Drive to Carpool Drive to Work Arrive at work 30-40 min 2 min 4 min • No more snooze • Shave on Sundays • Eat fruit at work • Select clothes prior night • Look at carpool process Before After 0-5

14. Recruiting Value Stream Map Hire Providers Providers Deliver Healthcare

15. Physician Recruiting Value Stream

16. Value Stream – Provider Perspective Provider Marketing Recruiting 3rd Party Agency Medical Departments Credentialing Patient Community Administration Ancillary Departments Provider Provider Provider

17. Value Stream – Departmental Perspective Provider Marketing Recruiting 3rd Party Agency Medical Departments Credentialing Patient Community Administration Ancillary Departments Provider Provider Provider

18. Integrated Value Stream Marketing Recruiting Human Resources Medical Departments Credentialing Patient Community Administration Ancillary Departments Marketing Recruiting 3rd Party Agency Medical Departments Credentialing Patient Community Administration Ancillary Departments Provider Provider

19. VSM Success Story Hospital in Southeast US • Expressed frustration with lack of time during the week to do the “things that mattered” • With completed Value Stream Map: • Apparent waste made obvious • Uncovered key behaviors that stifled productivity • Allowed us to create a “go forward” strategy • Re-captured 1 day per week

20. Lean Cycle

21. Monkey Story

22. The same old way? • To this point, it’s been about “understanding”, now it’s time to make changes • Create a culture of continuous improvement • Catalyst • Local and Executive Champions • Change is a threat when done to me, but an opportunity when done by me • Empowerment/Involvement

23. Kaizen • To change something and make it better • Continuous Improvement • A group of methods for making work process improvements • Cross functional • Rapid implementation • Low cost

24. Identify 7 Types of Waste • Defects • (Data entry or invoicing errors) • Overproduction • (Printing forms that may change before use) • Inventory • (Literature, office supplies, unread email) • Extra Processing • (Duplicating data, unused reports, relying on inspections instead of process) • Motion • (Walking to printer, looking for missing information) • Transportation/Handling • (Movement of paperwork, the infamous “forward/respond to all”) • Waiting • (Approvals, clarification, information)

25. Eliminating Waste Exercise

26. Tennis Ball Exercise • Each table is a team • We’ll play 3 Rounds • Each group will use 3 tennis balls • At the end of each round there will be a brief discussion • Each round is timed by the facilitator – pay attention to your facilitator • No practicing between rounds

27. Rules • Each team must stand in a circle • Each person must touch each ball once • All 3 balls have to start and stop at the same person • You are not allowed to throw the ball to the people standing directly next to you • 2 people cannot touch the ball at the same time • One person cannot touch 2 or 3 balls at the same time • Your process must be repeatable (3 rounds) • A dropped ball is a quality defect and you must start over (timer keeps going)

28. 30 Seconds to Plan Begin Round 1!

29. Round 1 Results

30. Round 2 Rules • Must keep the same order from Round 1 • Do not have to stand in a circle • Two people cannot touch the ball at the same time • One person cannot touch 2 or 3 balls at the same time • Must be repeatable • A dropped ball is a quality defect and you must start over (timer keeps going)

31. 1 Minute to Plan Begin Round 2! Round 2 Results

32. Group Discussion • What did you do to make improvements? • Did you use one person’s idea, or collaborate? • Did you draw out a plan, or just try it?

33. Final Round – Same as Round 2 • Must keep the same order from Round 1 • Do not have to stand in a circle • Two people cannot touch the ball at the same time • One person cannot touch 2 or 3 balls at the same time • Must be repeatable • A dropped ball is a quality defect and you must start over (timer keeps going)

34. 1 Minute to Plan Round 3 Results Begin Round 3

35. Summary Questions • What waste did you identify during the exercise? • How can we apply this exercise to our jobs? • Do you think you could improve further?

36. Kaizen Success Story • CompHealth Lead Response Time • VSM showed apparent bottlenecks in process • Kaizen created new process: • Reduced contact time from 64 hours to 7 minutes!

37. Kaizen Success Story • Hospital in the Southwest • Billing for locum tenens was the catalyst • Opened dialogue about internal and 3rd party payer credentialing • VSM highlighted apparent waste in existing process • Kaizen Results: • New process created better provider experience! • Reduced internal credentialing time by 42 days! • Provides earlier access to patient care!

38. Where do I start? Commit Leverage Resources VSM Choose Project Kaizen • Commit to continuous improvement • Partner with others in your value stream • Create your VSM • Choose a beginning project • Kaizen “It’s not what you look at that matters, it’s what you see.” Henry David Thoreau

39. Offer for Symposium Guests Jason Call jason.call@comphealth.com 801.930.3182 • Onsite LEAN event • No cost • Coach you through VSM/Kaizen • Leave you with the tools to continue utilizing LEAN methodology

40. Questions?