Case study: Helping an east coast medical group become a lean enterprise

The client is a large East Coast health system that has been a leading healthcare provider for over 150 years, serving the Mid-Atlantic and Southern states. Employing over 24,000 individuals, the system operates 20 hospitals and various healthcare facilities, including a medical group that provides outpatient primary and specialty care services.

The situation

The medical group faced several challenges as it pursued four strategic goals:

• Establishing consistent practices to unify the organization under its “One Health System” motto.
• Improving patient access by enhancing appointment availability and optimizing care locations.
• Increasing capacity to serve more patients effectively.
• Evolving into a lean enterprise to eliminate waste, streamline operations, and enhance patient care across primary, specialty, and acute care settings.

The solution and results

To address these challenges, the Lean healthcare team implemented several targeted interventions:

• Kaizen workshops. Fifteen teams across primary and specialty care participated in workshops aimed at improving access, reducing waste, and enhancing efficiency in processes like revenue cycles and rooming.
• Lean management system development. The client developed a lean management system to enhance management control structures, conduct A3 problem-solving, and foster lean leadership development.
• Flow improvement in a pulmonary clinic and beyond. A cellular design was introduced to streamline clinical and administrative tasks, reducing physician workload, and improving patient flow. Cellular design was subsequently spread to multiple clinics.
• Revenue cycle improvements. Standardized work for registration processes and reduced registration-related errors.
• Standard work for rooming and annual wellness visits (AWV). Created standard procedures to improve patient safety, screening rates, and Medicare reimbursements.

These actions led to significant improvements across the medical group:

• Access and scheduling. Appointment availability increased by over 10,000 annually, and no-show rates were reduced, saving $155,000 in lost revenue. Time-to-third-next-available appointments decreased dramatically, improving patient access.
• Surgical access. Added 1,708 visits across three specialties, with operating room utilization improving from 85.5% to 93.4%.
• Workplace organization. Reclaimed over 900 square feet of space, valued at approximately $15,000, and centralized inventory, freeing up 0.8 full-time equivalent of staff time using the principles of 5S — sort, set-in-order, shine, standardize, and sustain.
• Revenue cycle. Freed over 4,400 hours per year of staff time, worth over $100,000, and boosted reimbursement rates.
• Clinical improvements. Safety errors dropped by 6%, depression-screening compliance increased by 20%, and patient satisfaction rose by 5%. AWVs as a proportion of total visits jumped from 29% to 67%, with significant increases in cancer screenings and fall risk assessments.
• Lean leadership development. Empowered staff at all levels to pursue critical thinking strategies that advanced professional development and improved performance — not only for leaders coached directly, but also for direct reports. In one example, the cardiology program director and manager led a team effort to eliminate over 200 prescription refill calls weekly.
• Cellular design implementation. Reduced clinic lead time for patients by 14.5 minutes and physician time by 12.2 minutes per patient, generating significant capacity and cost savings.

Overall, these interventions resulted in an estimated financial improvement of $1.7 million since 2017, demonstrating the successful transformation of the Medical Group into a lean enterprise.