Knowledge Expansion

“Change is a scary word” — Owen Dahl on successful practice transitions, process improvement

Podcast

Practice Efficiency

Policies & Procedures

Chris Harrop
Consultant Owen Dahl, MBA, LFACHE, CHBC, LSSMBB, isn’t a fan of the word “change.”

“'Change’ is a scary word, I don’t like to use that word,” Dahl says. “I like to use the word ‘transition.’ We’re transitioning from the way we’ve always done it to a new way.”

Dahl has spent decades working in medical practice management with the goal of improving patient care, often through finding “opportunities for us to seek improvement in how we do things,” all with that end goal of quality patient care in mind. He led a preconference Lean Six Sigma Yellow Belt certificate program on Sunday, Oct. 13, ahead of the opening of MGMA19 | The Annual Conference in New Orleans.

How does Lean help in healthcare?

Dahl specializes in teaching the principles and concepts of Lean and Six Sigma. “Lean is really about reducing waste. When we talk about Lean Six Sigma, what we're doing is trying to eliminate waste,” Dahl says.

In a medical practice, waste occurs when patients are not efficiently moved from the reception area to the triage area or exam room. “There's just a number of things that can happen that are wasteful: You ordered the wrong lab test, you didn't get the results back from the consulting service that you were looking for. So you've got to scramble around trying to find things like that,” Dahl says. “Those would be gaps in what we refer to as an assembly line.”

“When I talk about this, doctors say, ‘Well, that doesn't make any sense. You can’t apply a manufacturing principle to how I take care of patients.’ Well, yes, we can, because there is an assembly line,” Dahl contends.  “As we think through how that assembly line works, we then can say, what can we do to make that process more efficient? Where are our roadblocks? Where are our gaps? What are our barriers that cause that flow of patients to be disrupted or delayed to the point that we're not as efficient as we could be.”

Being patient-centric

To assess the biggest issues for practice improvement, Dahl recommends beginning with a focus on the patient, starting with patient satisfaction survey results.

“What I like to do is ask, the last time you as a person went to a doctor's office, what was your experience like? … How long did I wait? Did I enjoy that time in that reception area? How was the interaction with the staff? Did I get my questions answered by the provider, the clinician that I interacted with? Was there good follow-up? All of those things are basic processes and basic concepts,” Dahl notes. “What I find is that it's not all of those pieces, but many of the pieces are broken. If we can find a way to get a 5% improvement in that process, I think we can gain a lot of benefit for our patients.”

Understand how your staff and providers operate

When you think about how most practices operate, it’s not hard to figure out why certain processes don’t work as managers intend, Dahl says.

“Physicians themselves are trained in a certain way. They're very efficient in terms of decision-making and analysis of the process that goes on in terms of patient care,” Dahl says. “Unfortunately, that concept hasn't translated necessarily directly from that physician-patient interaction to an interaction either with their management team, or that they've not been able to share that directly and get their management team to buy into that kind of idea.”

Practice managers may be good at measuring and analyzing things, but it will only lead to positive outcomes if the right problem is defined. When updates to workflows and policies occur without a level of buy-in, it’s likely that staff may “fall back into that security area where it’s ‘this is the way we’ve always done it,’” Dahl cautions.

That type of disillusionment can be costly for a medical practice, too, if it adds to staff turnover. “It costs you about 70% of an employee's annual salary in terms of replacing that employee … That's loss of resources, loss of time, interviewing processes” and more, Dahl notes.

Building buy-in

To avoid alienating staff and to engage more people in process improvement, Dahl recommends getting a strong amount of buy-in from the onset and investing the time in getting the plan right so that implementation goes smoothly.

“If you get people involved, you'll have more ideas, you'll do more brainstorming … and that can be a long-term process,” Dahl notes. “But then when you implement the change, it can be very short. As opposed to dictating the transition from above and telling somebody this is how they have to do it.”

Process owners — “people who are actually doing the work” — in a practice should be involved in developing a transition model and understanding Lean terminology. “You explain to them this is our purpose behind what we're about to do. This is what we've identified as the problem. … Get them involved, and all of a sudden, that implementation piece is much more effective in the long run,” Dahl says.

Conference takeaways

Dahl, who led the closing general session at MGMA19 | The Data Conference, has this advice for anyone who comes to an MGMA conference: “Stop for a minute and think about the top three things” you want to take back to your organization.

“By the end of a conference, all of the attendees have seen some incredible presentations … so they've got hundreds of things floating through their mind,” Dahl says. “You can't go away with 100 ideas. If you go away with 100, or 50 or 30 ideas, you're not going to follow up on anything.” Instead, think about what will benefit your practice the most and focus on that.

About the Author

Chris Harrop
Chris Harrop
Senior Editorial Manager MGMA

Chris Harrop is senior editorial manager for Medical Group Management Association. In this role, he serves as editor of MGMA's flagship print publication, MGMA Connection magazine, and oversees the publications team that produces the MGMA Member newsletter, Executive View, Student newsletter. Prior to joining MGMA, Chris was managing editor of multiple community news organizations in the Denver metropolitan area. Email Chris Harrop.

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