5S – Accepting Referrals from Other Health Care Practitioners

For those of you who accept referrals from other practitioners here are some tips to improving patient flow and ease the referral process. I’ve put them into the standard 5S format. Please remember that one of the keystones’ to 5S is transfer of responsibility to the employee. It is not enough to hand the ideas for de-cluttering referral management to the front desk and ask them to change. Instead, work through the 5S process and allow you’re administrators to take ownership for the changes and find the solutions best for you’re practice. Nine times out of ten front line workers come up with better ideas anyway.

Sorting: Keep the essential information only. A chart will be made in due time but rather than multiple pieces of paper/programs have a single resource for all referrals. This is especially important when more than 1 person is recording the referrals where two or three books could be maintained, each with multiple slips of paper for each referral.

Simplifying: The process needs to be simple. The best way to acoomplish simplicity is to computerize the referral process and have it integrated with the schedule. The referral is recorded, booked and if the patient cancels or no shows they go back on a call list. If not computerized create a process that simplifies all of the “what-ifs” in trying to book the consultation.

Sweeping: Ensure that all referrals have been entered and organized by day’s end

Standardizing: Have a uniform means of recording the referral and a standard method to organize the consult. If there is no answer, call back every 2 days for a week, then every 2 weeks. The frequency doesn’t matter so much as everyone in the office doing the same schedule. Also standardize the time where you book incoming referrals if you’re using block scheduling. Eg. You receive X referrals / week so you’ve blocked X time slots per week.

Sustaining: Have a back-step process to look for patients that are still on call lists but are not being contacted. Our office has a small query created that looks for patients that are still on the call lists but not being called. Where we find a group of patients that fall into this category we change the process.

For some of our referrals the system is very slick. They email the referral which is automatically imported into the referral management system/EMR. It shows on the call list as "EMAIL" and the administrator enters the information (any xray's are attached). When the administrator hits "save" an auto-email is sent back saying "Your patient Joe Smith was entered on April 29, 2008 by IFurst in our XXX office and will be contacted in 1 business day". The patient is then contacted, treated and the correspondence back to the referring doctor is by email as well.

Spring Time Reminder

This is you're spring time reminder to clean off you're desk, clean out your inbox and take a look at the office to remove any unused or broken equipment and supplies. 5S (Sort, Simplify, Sweep, Standardize, Sustain) improves morale and increases efficiency.

If you'd like to take a look at the fun side of office efficiency from the corporate side of things go over to Pimp my Work. A lot of it is tongue and cheek but they've also got some good ideas (no affiliation - I just liked the site).

The picture below has nothing to do with 5S - my friend decided to plow the pond with his truck! In the end it took 9500lbs worth of wench to get him out. Good fun.

5S - The Foundation of Improving Process

5S (Sort, Simplify, Sweep, Standardize, Sustain) is the philosophical basis for improvement of health care wait times. There are only so many scheduling “tricks” and reallocation of resources that can improve patient flow then process must be advanced. 5S is a reference to a list of five Japanese words that start with the letter S. In Japan, businesses and people adopted it as a way of life. In North America and the UK we view it as a means to improve process.

The two key targets are to improve morale (with a clean work environment and ownership) and improve efficiency (by decreasing clutter and adding visual cues). Think of a surgical tray. For a practiced surgeon or scrub nurse/assistant; if even a single instrument is out of position it’s noticed. There are visual cues on the tray for procedures such as notes to give antibiotics in the prep tray, or a note to “time out” (check the procedure) with the marking pen. Another example is the resuscitation room where passionate arguments can flare about the best location for the defibrillator. Both are examples of 5S.

The benefits come from the employee deciding what should be kept, where it should be kept and how it should be stored. The process transfers ownership of the process to the employee and builds a clear understanding of work flow. It can be as simple as re-organizing the desk of an administrator (see this story for an extreme example of a disorganized desk leading to disaster) or as complex as cleaning and reorganizing an ER to optimize patient flow.

The 5S’s are:
Seiri (整理): Sorting. The practice of storing or discarding all but the essential tools/materials for a process to decrease hazards and clutter.
Seiton (整頓): Simplifying. Creating an orderly workspace that puts tools and materials in a place to minimize extra movement and improve workflow.
Seisō (清掃): Sweeping, Systematic Cleaning, or Shining. Making cleaning an area part of a daily routine and build it into the routine of workflow (usually at the end of shift) rather than a sporadic action.
Seiketsu (清潔): Standardizing. Whereas systematic cleaning is making an area clean, Seiketsu means standardizing the workflow so any repetitive work is conducted in the same manner.
Shitsuke (躾): Sustaining. Regularly reviewing and improving the 4S’s above.

The 5S’s are well proven in real world applications to improve productivity and morale (Toyota, Hewlett-Packard, Boeing to name a few). By improving patient flow by 10% in the OR there could be a corresponding drop in surgical wait times by 10%. For the GP’s out there, how many times in a day do you have to go “hunting” for materials for a routine patient (swabs, requisitions, etc…)? Hunting for pens & stethoscopes in hospitals is a running joke. It is not enough for the practice manager, administrator or provider to be the only believer in the system. 5S is a concept about global changes and ownership of process by the people that provide it. Adopt 5S, and then apply it to processes in a practice both big and small.