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5 Common Barriers to Patient Flow and How to Remove Them

June 17, 2024
5 Common Barriers to Patient Flow and How to Remove Them

We recently discussed the five most common causes of excessive wait in eye care clinics, and while some of these causes may be readily identifiable, what lies behind them may not. We know that when patients flow through the clinic smoothly and seamlessly, clinics can achieve maximum capacity and profitability, and everyone – providers, staff, and patients – is happy. However, when barriers to this flow occur, processes are disrupted and patients are made to wait, resulting in a poor patient experience and lost revenue for the clinic. In this post, we dig a little deeper into the most common barriers to patient flow and return to Lean Management principles to help remove them. 

While there will always be a certain amount of normal process variation due to unavoidable causes such as a staff illness, a wifi disruption, or someone just having an “off” day, this post will focus on the most common preventable barriers to continuous patient flow. 

Barrier #1: A Lack of Communication – “I Didn’t Know!

When patients are made to wait because someone didn’t know they were ready, or a room was available, or equipment was free, that is inexcusable. Inefficient handoffs from one step in the process to the next are perhaps the most common reason for patient wait times and occur largely because the next person in the workflow was unaware that they could proceed. This lack of visibility into, and knowledge about, what is happening on a macro level and what actions are needed to move the process forward raises questions such as:

  1. Is the patient ready to be seen?
  2. What rooms are available for use?
  3. Which patient is next?
  4. What equipment is free to use?
  5. Is screening complete and is the patient ready for the provider?
  6. Are backlogs occurring and how can I help?

Every member of the care team should know the answers to these questions so they can help keep the workflow moving smoothly.

Remove the Barrier: Visual Management 

The simple fix for removing this barrier is to make the information readily available and instantly visible. Visual Management, which uses visual cues to help the team identify and correct problems in real-time, is an integral component of Lean Management and is the key to getting everyone on the same page. When a patient is tracked along each step of the workflow in real time and their status and location is visually documented, there can be no ambiguity about whether they are ready for the next step, or if a room or staff person is available. It’s all there in black and white. Staff members can ask themselves “what do I need to know?” and “what do I need to share?” and feel empowered to take it upon themselves to keep the patient moving. When every team member has full visibility into immediate patient needs and treatment room and equipment availability, they are able to react quickly and contribute effectively to a smooth patient flow.

Barrier #2: Delayed Staff Response – “I Didn’t Go.

Slow response times can be the result of a number of things, including interruptions for administrative or management matters, being offline for breaks or personal matters, spending time on indirect care tasks, or taking longer than usual to perform standard tasks. When these delays interfere with smooth patient flow they lead to provider downtime and/or backlogs, both of which affect the patient experience, staff and provider satisfaction, clinic capacity and profitability.

Remove the Barrier: Prioritizing Direct Care

In the clinic setting, we need to prioritize direct care. If we know that response times are slower because of activities that are unrelated to direct care, we need to build in some time during the day when these tasks can be completed without impacting patient flow. A task accomplished without causing provider downtime might cost 50¢ per minute of staff time, for example, while a task accomplished in lieu of direct care, can cost $20 per minute of care team time plus $30 per minute or more in terms of lost revenue. Consistently slow response times may also indicate that extra training or support is needed, or that the workflow needs to be re-examined to create greater efficiency. Setting reasonable but meaningful targets for responding to next-patient direct care needs can help staff stay on track. 

Barrier #3: Redundant or Unnecessary Work – “Oops, I Did It Again.

When using a Lean approach to map the processes – or value stream – in your clinic, you might identify certain tasks that consume resources without adding any real value. For example, asking a patient a question that has already been asked by and answered to another caregiver, fixing or completing work not done correctly at a prior step, or performing tests or procedures not justified based on evidence-based protocols. This unnecessary work wastes time causing bottlenecks and delays in the workflow. 

Remove the Barrier: Value Stream Mapping & Quality Improvement

Another key element of Lean Management is continuous improvement, and an in-depth analysis of your clinic’s workflow, or value-stream, will reveal where process improvements can be made. Team meetings during which goals and processes are discussed can help identify areas for improvement and a review of evidence-based guidelines and care protocols will also uncover areas in which unnecessary tasks are being done. Through team-based quality improvement and feedback, you can streamline your processes and remove this barrier. 

Barrier #4: Capacity Conflicts – “I Don’t Have a Room.” 

Delays and waits that occur due to an actual lack of available resources are a true barrier. We can identify three types of capacity constraints: 

Type I:   Patient is ready for direct care but staff is not available.

Type II:  Patient is ready for direct care but room is not available.

Type III: Patient is ready for direct care but staff and room are not available.

Not all constraints are created equal, however, and before adding additional resources to alleviate these capacity conflicts, stop to consider whether they are truly necessary. Applying Lean Management often allows clinics to increase capacity without additional resources.

Remove the Barrier: Efficient Scheduling & Time-Balanced Workflows

Potential capacity constraints can often be addressed by other means, such as more efficient scheduling, appropriately time balancing the tasks that lead up to the time spent in direct care, and reducing variation in how work is performed. Understanding provider work patterns and the length of time required for examinations and procedures allows practices to adjust and maintain the rate of patient arrivals to match the flow pattern of the provider. Once you know the rate at which patients should be scheduled, the entire workflow leading up to the provider’s patient exams should also be appropriately time-balanced to ensure the doctor is seeing a patient in the exam room at a regular cadence. In our experience, when clinics optimize the flow of patients, they often find that capacity issues resolve themselves. To learn more about how to determine each provider’s flow pattern and how to schedule patients accordingly, read our post about using takt time to help clinics achieve maximum capacity

Barrier #5: Unnecessary Process Variation – “I Can’t Find My Glasses!

As illustrated in the example below, a clinic workflow analysis might show that some team members consistently work less efficiently than others. While staff member NRS is an experienced veteran at the clinic with excellent performance results, DC shows some significant productivity challenges. When this variation is caused by an assignable cause, including deviations from standard work or approved protocols, training deficits, equipment or computer problems, missing or misplaced supplies, or any other identifiable reason that causes a delay in the standard workflow, it must be addressed.

Removing the Barrier: Standardized Work & Organized Spaces 

One reason that team members show variability in the process is that they don’t fully understand or know how to do the tasks required. The best way to avoid this is having well-defined and documented standardization. Providing clear and effective instructions, and determining how long each standardized step in the process should take helps team members take accountability and collaborate seamlessly in support of shared goals. Proper implementation and standardization of the workflow streamlines processes, facilitates training, increases quality, and elevates the patient experience. It also supports the concept of continuous improvement, an important aspect of Lean Management.

Sometimes, delays are caused when staff can’t easily find what they need to complete the task, or are distracted by a cluttered workspace, or hampered by a glitchy device. When unnecessary variations are caused by an inefficient workspace, clients often turn to the 5S methodology to ensure a more organized and productive environment (another lean management principle.) The five steps involved are: 

  1. Sort (get rid of unnecessary items to reduce distraction), 
  2. Straighten (organize those that remain so they’re readily at hand), 
  3. Shine (make sure the workspace is clean and all equipment is functioning properly),
  4. Standardize (write down how you’d like the workspace to function so everyone can follow best practices), and 
  5. Sustain (inspect the space regularly to ensure it’s up to standard.) 

Using other quality improvement tools, such as fishbone diagrams or the A3 problem solving method to identify and reduce unnecessary process variation can also help streamline patient flow, and instill a culture of quality, productivity, and improvement. 

Using Lean Management to Remove Barriers to Continuous Patient Flow

Visual Clinic’s visual management and clinic workflow solutions help eye care clinics all over the country improve efficiencies and remove barriers to flow so they can achieve maximum capacity. Our range of software solutions, based on Lean Six Sigma management principles, has been helping clients optimize their practices for more than a decade. Through a careful analysis of patient flow and resource allocation, every eye care provider can use the basic principles of Lean Six Sigma in their own clinic, even without outside assistance. 

Contact us if you’d like more information about how Visual Clinic can help remove barriers to flow in your clinic or book a demo.

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