Why do people shut down when the word efficiency is used? Is there so much negative connotation that we can no longer see the benefits? I reached out to five different people in the #QualityPT world and no one wanted to tackle this one!
What you need to know about the “E word”
I recently left an academic health science centre where many of us cringed whenever we heard the “E word”. To us, “efficiency” meant job cuts. And because of funding issues, there werereductions. After each round of layoffs, all in the name of “efficiency”, we had to learn how to do more with less. So to me, the “E word” conjured images of my smaller team.
The term was not used lightly.
But was it all bad? Yeah… that part really was. As professionals, we still had to provide the best quality of care to our patients with the resources that we had.
Because of smaller team, we finally gave in and adopted a version of electronic charting (typing into a word form, which is uploaded as an attachment to an electronic chart.) For some, this process increased efficiency. One physiotherapist reported that when working on the weekend, moving from one unit to the next, her time was wasted when her patients were not ready to see her. She had to find something to do while she waited. Now, she could sit down at any computer and document patient care provided to patients throughout the hospital.
That was a good change, although for PTs who still type with two fingers, this change certainly slowed them down.
During my Lean Green Belt certification, I tackled a project that I had been avoiding: equipment management. Having moved to program management over a decade ago, we had absolutely no control over purchasing, servicing, tagging, inventory management or storage. After speaking up at the right meeting, at the right time, and to the right person, the stars aligned. An inventory controller was hired for six months to declutter hospital units. I quickly attached myself to the project and convinced them to use Lean tools to complete the physiotherapy equipment project.
Before the decluttering, a lot of time was wasted looking for the right piece of equipment for each patient. There were “have” units and “have not” units, depending of the level of support and available budget held by each unit manager.
Some physiotherapist assistants (PTAs) had to spend 20 minutes taking everything out of the equipment room in order to reach that one piece that always seemed to be buried at the back (only to stuff everything back in again!).
After trial and error, measurement, standardized tagging, pooling and redistribution of equipment, most patients now have access to the equipment they need and less time is wasted.
Here’s why being efficient is important
The Institute of Medicine defines being efficient as: avoiding waste, including waste of equipment, supplies, ideas, and energy. Efficiency is often equated with layoffs. However, efficiency is really about avoiding waste.
By avoiding waste, we save money, time, and energy; all of which can be used elsewhere.
All of these things can increase efficiency thus save money/time/energy:
- Are PTAs being assigned tasks that do not require the specialized skills of a physiotherapist, thus freeing up the PT’s time to assess and analyse the complex patient?
- Is the right number of supplies used for each patient?
- Are your patients being asked to fill out electronic patient reported outcome measures, such as FOTO, in the waiting room?
- Is your equipment well organized and easy to access?
What you need to know about efficiency
In order to be efficient, the first step is to identify waste. Once you’ve figured out where your waste is, talk to the people actually doing the work to come up with solutions.
You can use a Plan/Do/Study/Act (PDSA) cycle of quality improvement to implement and evaluate changes. Or you can use a process like Lean.
The result should be increased time for PTs and/or PTAs to do the things they need to do.
One example that we came across was the need to fax documents.
Waste was identified: PTs type up the patient’s discharge summary, print it, fax it to the institution the patient is being transferred/referred to.
Why can’t they just push a button from the electronic medical record (EMR) to send it? Well, because “the system was designed that way.”
Hmm. I left before we fixed that one.
It’s not that hard to identify waste. Usually, I come across something and think “that’s dumb, why are we doing it that way?”
Others may refer to this as cautionary. Staff is your best source to identify waste, unless it has become so ingrained because “it has always been done that way.” Hopefully not.
If you’ve experienced the “stay the course” kind of response, a great idea is to seek external advice: ask your patients/clients or other outside person.
Think about all the time you’ve spent sitting in a waiting room. Did you find that an efficient use of your time?
Common challenges associated with efficiency
- It can be difficult to get staff buy-in, especially if they’re living in fear of being laid off. If they aren’t involved from the beginning, and through the implementation, change management can be that much more difficult.
- Another common challenge is being stuck in your way of thinking. If it’s difficult to find solutions to your “waste”, try using one of these tools to get your team thinking outside the box.
- Making changes are difficult. Finding time to address efficiency when you are run off your feet, have no time to reflect and think through from problems to solutions, can make the process even more difficult.
Potential consequences associated with inefficiency
A repercussion of being inefficient is that your patients might not receive the level of quality physiotherapy that they require. Many things are beyond our control in an imperfect health care system.
The great thing about efficiency is that there are many things within your reach to fix – you just have to start with one problem at a time.
Three things you can do right now in your practice:
- Look around you right now. Is there any part of your practice that’s not efficient? What can you list right now? If you can’t think of any, ask your patients.
- Use the PDSA cycle of quality improvement. Break the problem up into small chunks; learn more about efficiency, and consider getting your yellow or green belt in Lean methodology certification.
- Create an environment where your staff can bring ideas forward; empower them to make changes. At your next team meeting, throw out the question “what can we be doing better?” If you’re a clinic or team manager, start asking your staff “what can we be doing better?”
Don’t ignore that caution light… trust your gut. Stop. Reflect. Act!