Lean Six Sigma Brings Efficiencies to Oncology Practices

• Case 3. Again, scheduling, registration, and patient flow were frustrating and inefficient in a clinic. "They found that there were actually too many people in the process," Dr. Fryefield said. After assigning one person to scheduling and then reassigning the rest, productivity improved as the number of patients per FTE (full-time equivalent) staff increased by 17%.

• Case 4. Chaotic procedures resulted in an unhappy staff in this oncology practice. Lean Six Sigma showed inefficiencies in almost every aspect of care delivery, according to Dr. Fryefield. When best practices were implemented and various processes were streamlined, the volume of new patients increased by 22%, and productivity increased by 10%.

Experience with the PQE program using the Lean Six Sigma method has provided some important overall lessons, summarized Dr. Fryefield.

"Clearly, oncology practices are full of inefficiencies. That’s not really surprising," he said. Historically, "when we would try to solve problems in our clinics, we would just do something that seemed like a good idea, but it turned out that it was expensive or inefficient, or sometimes both."

Furthermore, although practice size, composition, and dynamics differ along with local markets, the inefficiencies and process defects are often similar. "For instance, the lab is always a bottleneck," he noted.

Overall, by using Lean Six Sigma, the PQE program has shown some impressive tangible benefits in the four process areas it focuses on, according to Dr. Fryefield. On average, participating practices have seen the following changes:

• A 3%-5% growth in patient volume (referral development).

• A 6%-8% increase in visits per staff full-time equivalent (care delivery).

• A 3%-5% improvement in costs with better cash flow (revenue cycle).

• A $1-$2 million increase in practice earnings (drug management).

"There isn’t anybody who can come in and do this [process] for you. Everybody in the practice has to [buy in], and that really starts with the docs," Dr. Fryefield advised. "They have to be part of this solution. If they think they are separate from this, they are wrong; MD leadership is essential."

Other senior practice members – executive directors, managers, and so on – also must be solidly on board, he said. And staff at all levels should be polled for their input and, ideally, be actively involved. The process also requires a commitment to change. "Change is never popular unless everyone thinks it’s their idea," he noted.

"PQE is a journey, not a destination," Dr. Fryefield concluded. "That’s one of the things that’s a little difficult for doctors to understand because doctors like to fix things and then move on. Some of my docs will say, ‘When is the change going to settle down?’ And the answer, of course, is never."

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