Lean process workflow. It sounds like something straight off an assembly line – not words you expect to hear in a medical setting – but that’s exactly what’s happening at Dayton Physicians Network urology.
Cutting-edge, lean management and optimizing work flow practices are at the forefront of an innovative approach in collaborative care to treat patients, in light of a shortage of urologists in Dayton and across the United States.
There should be approximately 17,000 urologists based on our population. Currently, there are less than 10,000 active urologists in the United States, and over the next two years, that number will decrease to 8,000, due to retirement.
Not only is retirement decreasing the number of practicing urologists, but as the population ages, urologists are in greater demand – a convergence Dayton Physicians urologist David Key, MD, and his colleagues have been strategizing for the past few years.
The solution came when Key was talking with a friend, who shared how she uses workflow mapping in her business. He recalls their conversation, “I said, ‘Workflow mapping? Show me what you’re talking about.’”
The conversation inspired Key to do more research, eventually following a trail that led him to discover the Virginia Mason Institute in Seattle, Wash., where lean management processes are translated into the healthcare setting, with great success.
“They took the Toyota model of production, looked at efficiencies, and actually applied those practices to the health care industry,” Key said. “They even went over and visited Toyota in Japan. Virginia Mason has perfected the system to the point that Japanese hospitals are now sending their folks to Seattle for training.”
Key and a team from DPN visited the Virginia Mason Institute in 2018 and brought back the methodology. Team members have since been trained, and the new system was launched in July.
Shorter wait times for new patients
Before implementing the new approach to patient care, Key and his Dayton Physicians colleagues together would see an average of 250 new patients a month. “In only two weeks, under this new model, I saw 112 new patients, which extrapolates to over 200 patients for just one doctor over the course of a month,” he said.
Providing fast care for acute needs, the collaborative care model means new patients aren’t waiting five to six weeks to be seen. Instead, patients are being seen within 48 hours of an emergency room visit.
“The problem we were trying to solve for was how to address the needs of our community and allow urologists to take care of patients with the most need, while continuing to serve new patients,” said Dr. Key.
With this as the primary driver, urologists at DPN are now paired with nurse practitioners in a collaborative care model. One doctor is paired with a nurse practitioner and two medical assistants. Nurse practitioners see established patients, under the plan of care laid forth by the urologist. The urologist then is able to focus on surgeries and creating care plans for new patients. The office currently has four nurse practitioners, and Key foresees that number increasing to around eight.
Before being independently involved in patient care, each nurse practitioner participates in a three-month training program. “The training program within our group is pretty strenuous,” Key said. “We are very pleased with our nurse practitioners. They are outstanding.”
What started as a solution to solve the growing shortage of physicians has produced surprising results that are, most importantly, creating better patient care.
“This model allows you to overcome the shortage of physicians, addressing patients needs in shorter time, which increases patient satisfaction and, ultimately, outcomes because you’re treating them in a much quicker fashion,” Key said. “It’s changing the face of how we see patients.”More Perspectives