“Single Piece Flow” in Medicine
I've always enjoyed my discussions with Sami Bahri, D.D.S., the “World's First Lean Dentist.” One concept he talks about, most recently in our video podcast, is the application of the Lean concept of “single-piece flow” to dentistry and his patients.
Dr. Bahri's brilliant question was to ask, “Why does the patient have to come back for multiple visits to receive their complete care?” This led him to change processes to take care of almost everything in a single visit – find a problem, fix a problem.
I got an email from a reader of a similar primary care situation:
I listened to the podcast with Dr. Bahri.
My wife was at the doctor Friday for what appears\ed to be heartburn / indigestion. They ran an EKG, which was normal. As defensive medicine, I suppose, they want to run an echocardiogram. They could have done it at the doctor's office at the same time as the EKG, but the insurance company won't pay for it there, so she has to take this afternoon off to go to the hospital instead.
So much for single piece flow – so much for taking care of the customer's needs in a convenient way. In this case, it sure sounds like the dysfunction comes from the insurance rules. I've heard of similar dysfunctions where outpatient physical therapy has a different rate than inpatient physical therapy — different pay for the same work.
Have you run into similar situations? Dr. Bahri was able to improve his patient flow since there wasn't a financial impact, it seems – same pay for the same work done in one visit or multiple visits.