Amazing Single Piece Flow MD Office


MedQIC – Patient-Centered Care Supported by an EHR

The link above (and this audio-video presentation with similar content) tell an amazing story of a private practice family physician who has a “single patient flow” process in his office.

This doctor re-thought the entire patient process, from the perspective of a patient. He was inspired to do this after he had a lousy experience being a patient for another physician.

Imagine this sort of experience as a patient:

  • You show up for your appointment and walk to the counter. You say “I'm here” and don't have to sign in or do anything.
  • You are immediately walked to your exam room where an assistant takes basic information and enters it directly in their Electronic Health Record (EHR) system that's right there in front of you.
  • On average, 63 seconds (SECONDS!) later, the MD comes in and sees you. The MD sees the information that the assistant took down so you don't have to repeat yourself. While talking, the MD takes notes directly into the EHR (while not really losing eye contact from you).
  • When done, you walk to the front desk, where you wait, on average, 60 seconds to get a print out detailing your next appointment, lab work that might need done, and a printed (not handwritten) prescription.

On average, their “value added” time for a patient is 91% of time on site, 22:12 out of 24:24 overall spent in the office. The doctor isn't being “efficient” by being short with the patients and by rushing them through.

This is clearly efficient from a patient standpoint. The office's goal is to never have you sit in the waiting room.

This is also efficient from an MD standpoint. Dr. Griffin spends 61% of his time on direct patient care, and a total of 88% of his time in exam rooms, which includes doing the charting while talking to the patient. In most offices, the MD does charting at the end of the day, which has an impact on the quality of the notes that are taken. Taking the notes in front of the patient also gives the patient a chance to ask questions, which reduces the number of times Dr. Griffin is interrupted by patients calling back with questions. When the MD and patient walk out of the room together they are “just done” with no follow up work for the MD.

It's a great story. I love the one comment from Dr. Griffin — it absolutely relates to the ideas of the book Lean Solutions:

“Respect for patient time is a business model.”

I love it.

Two other great lessons and keys to Dr. Grffin running his office in this “lean” way:

  • Engaged and committed staff – zero turnover in seven years
  • Proper selection and customization of the EHR system — selecting software that allowed Dr. Griffin to practice medicine the way he wanted.

These are both great lessons for lean in a factory setting. In far too many factories, the process is dictated by limitations of the ERP or MRP software. Dr. Griffin has it right — design the process first and have software that supports your lean process.

Part of me is skeptical — how can Dr. Griffin's appointment times be so predictable? What happens if Patient X takes longer than he expected. I'm sure some patients must be delayed once in a while. What happens with patients who show up late? But you know, most patients show up late because it's “OK” – they expect the MD to be running late anyway, it's a vicious cycle. I bet that when the MD respects your time, you the patient are more likely to respect their schedule.

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Mark Graban
Mark Graban is an internationally-recognized consultant, author, and professional speaker, and podcaster with experience in healthcare, manufacturing, and startups. Mark's new book is The Mistakes That Make Us: Cultivating a Culture of Learning and Innovation. He is also the author of Measures of Success: React Less, Lead Better, Improve More, the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, and the anthology Practicing Lean. Mark is also a Senior Advisor to the technology company KaiNexus.


  1. Hi Mark,

    you wrote, “Part of me is skeptical — how can Dr. Griffin’s appointment times be so predictable?” wondering how LEAN can be achieved in the medical field.

    Myself, I made very positive experiences during my student time in Bamberg where I had a dentist (chosen by chance, it was the closest one to the student housing). Making an appointment (and there had been several even after I moved out of Bamberg later on) was always a pleasure, because once you had the appointment you could be that when arriving there was not enough time to read the paper five pages and then work started (finished in excellent quality in the least time necessary). It was a real one-piece-flow (even though in 1991 “Lean Thinking” wasn’t yet published, there were never more than one client in the waiting room.

    I really loved going there because I didn’t loose any -even during student time- valuable time:-))

    …so you can see LEAN is possible in areas where you wouldn’t expect it:-)

    All the best from Leipzig


  2. Ralf – thanks for your comments. I know lean is possible… I’m just surprised that the human element (variability in treatment time and patients arriving late) doesn’t trip things up more often. Still, his system is better than my family practice office here in Texas. I’m about to find a new doctor because I’m tired of waiting too long once I’m there. I wonder if they care? They have a huge waiting room that’s decorated very nicely — a bad sign! They expect too many people to be out there far too long.

  3. Make sure to emphasize that this doctor wasn’t “working harder” in the course of doing his work different. Quite the opposite, I think he was far less stressed out than he was under his old approach.

  4. Mark,

    the smooth process was possible because the patients said clearly what the reason for their coming was (and the dentist knew the specialities of his clients’ teeth). So the dentist could decide how much time was needed for treatment. Coming late you would just let happen once because afterwards you would learn you had to wait till an appriopriate time window to be fitted into the tied schedule.

    ….and yes you are right: thís dentist was really working smarter not harder (he wasn’t stressed at all -as far as I could say).




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