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 3 rd 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 Perfection Specify Value Map Value Stream Create Flow Pull

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 Perfection Specify Value Map Value Stream Create Flow Pull

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 Shower Facial Hair? Yes No 9 min 0-15 # Steps2 Time:12-27 Waste:0-15 Value:12 Shave 3 min

11. Morning Routine VSM (Current State) 6:20 Alarm Snooze 6:25 Alarm Snooze 6:30 Alarm Shave Teeth Hair Clothes Breakfast Arrive at work Drive to Carpool Lay in bed Check Email Get out of bed Shower Facial Hair? Yes No Late? Hungry? No Yes No 5 min 5-10 min5 min 9 min 3 min 2 min.5 min6 min 5 min4 min Drive to Work 30-40 min.5 min 0-15 # Steps13 Time:80-110 Waste:20-50 Value:60-70

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 Arrive at work 0-5 Get out of bed.5 min Shower 5 min Teeth 2 min Hair.5 min Clothes 2 min Drive to Carpool 4 min Drive to Work 30-40 min # Steps7 Time:44-59 Waste:0-15 Value:44-54 # Steps13 Time:80-110 Waste:20-50 Value:60-70 No more snooze Shave on Sundays Eat fruit at work Select clothes prior night Look at carpool process BeforeAfter

14. Recruiting Value Stream Map Hire Providers Providers Deliver Healthcare

15. Physician Recruiting Value Stream

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

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

18. Recruiting Medical Departments Credentialing Patient Community Administration Ancillary Departments Human Resources Marketing Integrated Value Stream Recruiting Medical Departments Credentialing Patient Community Administration Ancillary Departments 3 rd Party Agency Marketing 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 Perfection Specify Value Map Value Stream Create Flow Pull

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. Begin Round 1! 30 Seconds to Plan

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

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. Round 3 Results 1 Minute to Plan 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 3 rd 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 Onsite LEAN event No cost Coach you through VSM/Kaizen Leave you with the tools to continue utilizing LEAN methodology Jason Call jason.call@comphealth.com 801.930.3182

40. Questions?