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Timing is Everything: Understanding Takt Time to Reduce Door-to-Doctor Time

April 4, 2024
Timing is Everything: Understanding Takt Time to Reduce Door-to-Doctor Time

As we pointed out in our article on using Lean Six Sigma principles to improve efficiencies in eye care clinics, patients come to your clinic for one thing: to be seen by a doctor. In other words, the “value” of your clinic, from the patient’s perspective, is only the time spent in direct care with the doctor, and not in the time spent waiting for that care to occur. It follows, therefore, that in order to create more value for patients—and, by extension, the business itself—clinics should strive to maximize direct care. 

In our discussion of capacity vs capability, we show that maximizing direct care results in achieving true clinic capacity. We emphasize the need to avoid overloading the system, which creates bottlenecks and unnecessary wait times, and to streamline the workflow. To achieve maximum clinic capacity while also providing an exceptional patient experience, the right number of patients must be scheduled at the right time intervals to create a steady flow that can easily and efficiently be handled with existing resources, with little to no wasted time. 

Marching to the Beat of the Doctor’s Drum

When a doctor has too many patients scheduled to be seen in a day, it puts stress on the system, causing patient, staff, and doctor dissatisfaction. Too few patients, on the other hand, allows room for idle time and leads to potential lost revenue. 

When bottlenecks occur, however, patients are made to wait. These bottlenecks can often be eliminated by correctly pacing the number of patients coming through the workflow — in other words, scheduling the right number of patients at optimal time intervals to keep things moving at a steady pace: not too slow, not too fast. Think of it as the drumbeat of the practice.

According to Lean management principles, every process has a pace-setter step which is the one step in the workflow to which all other tasks must be timed. It is this step that determines how fast the drum beats. 

In an eye care clinic, the pace-setter is the doctor because direct patient care is where the value lies. Therefore, the length of time the doctor needs for a typical exam dictates the rate at which his or her patients can be seen, and all steps in the workflow leading up to the exam must be time-balanced to the pace of the doctor, including patient arrivals. 

Using Takt Time to Determine Pacing

Ideally, workflows should be optimized to keep the cadence of each doctor’s drumbeat steady. In terms of a Lean management approach, this cadence is referred to as takt time (“takt” being the German word for “tempo” or “pace”) and it is determined according to each doctor’s unique practice patterns. In order to determine the optimal cadence, or pace, for each doctor, we need to calculate his or her takt time.   

It is important to understand that takt time is a function of utilization and the average length of an exam, and is individual for each doctor. Let’s look at Dr. X as an example: In a typical 8-hour workday, clinic data shows that Dr. X spends 70% of her time on direct patient care and spends an average of seven minutes with each patient. Therefore, she has the capacity to see 48 patients in a day: 

480 minutes in a day x 70% utilization = 360 minutes of direct care available

360 minutes ÷ 7 minute direct care exam time = 48 patients

To most efficiently schedule her patients, we must also take into account the remaining 30% of her day, which is the time spent on typical indirect care tasks such as correspondence, phone calls, interpreting test results, breaks, etc. In order to calculate Dr. X’s takt time, i.e. the pace at which she can see patients, we must consider both direct and indirect care: 

This means that the entire workflow leading up to each of Dr. X’s patient exams should be appropriately time-balanced to ensure the doctor is seeing a patient in the exam room every 10 minutes. Bear in mind, takt time is not the amount of time spent with patients: It is the pace at which patients should enter and leave the clinic to stay on time and meet demand.

If patients are checked in, screened, and pre-tested at a pace faster than the doctor can see them, it creates a logjam in the waiting room, frustration for the patient, and stress for the doctor as she tries to catch up. 

If patients are moved through these processes at a slower rate than the doctor is able to examine them, then the doctor will not be working at peak capacity as there will be times when there are no patients to see. These slack times may also tempt the doctor to slip away to her office, thereby further derailing the flow and disrupting that all-important drumbeat. 

Patients who move through the workflow in increments of the takt time do so in a smooth, continuous fashion, making for a better patient experience and moving the clinic closer to maximum capacity. Eye care clinics that understand and utilize takt time as a business and care tool, will optimize patient flow to reduce door-to-doctor times and achieve peak efficiency. 

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