Gemba is a Japanese term meaning “the real place.” In medical practices across the country, administrators are taking the walks to the “real places” in their practices – the front office, the exam rooms, the business office, and throughout the halls of their practices. Administrators are performing Gemba walks in order to observe work-in-progress, engage with their team, understand the work process, and identify opportunities for improvement.
A Gemba walk features personal observation of work by dedicating time to observe and interview those who are closest to the work. Instead of reviewing results, deducing opportunities, or promulgating recommendations from the confines of an office, the Gemba walk involves physically walking through the process – and speaking with the team members who are actually doing the work as they are the best candidates to see, understand, and solve problems.
The focus is on the process, many of which were put in place years ago. And, if we do anything well in medical practice operations, it’s doing things like we’ve always done them in the past. This isn’t meant to be a compliment – in fact, it’s time to question ourselves – listen, observe, inquire. Why do we do it this way? How can we do it better?
This procedure can be applied to any work stream: immunizations for well-child checks, scheduling new patient appointments, processing faxed-in referrals, or working an insurance denial. You may discover that immunizations are not always charged; new patients may be abandoning their phone calls because of outdated call routing; fax-in referrals get printed, copied and filed before worked without any acknowledgement; and denials for registration-related errors are written off due to lack of resources. These “aha” moments will not come from reviewing a report, receiving a patient complaint, or reading an email – they come from actually seeing the work being done and improving it on the spot.
One word of caution: Often, the team will not recognize an opportunity because the barrier (or problem) has existed for so long. Be respectful; do not point fingers. Instead, build trust by coaching the person who is showing you the work when you discover a problem, instead of blaming.
Challenge yourself and your team to develop your own solutions with Gemba walks that help you find new ways of working and connecting with patients, while improving the efficiency and effectiveness of your practice operations.
Tips on Getting Started
Establish a standard set of questions for your Gemba walks, focused on each process you’re observing. Ask: Who is involved? What do you do? Why do you do that? Can you show me? What materials are used? How do you know what to do? When does the task take place? What depends on the outcome? How can the task be improved? What road blocks can I remove?
Or, give “trystorming” a chance! We’ve all heard of brainstorming, but what about “trystorming?” Trystorming is a technique that combines brainstorming with action based on the rapid testing and implementation of an idea. Come up with a potential list of solutions; instead of merely thinking about ideas, take action to test the best solution. If it fails, try the next one. This concept is an exceptional one to review with your team before you start your Gemba walks. It helps to create a culture of action – infused with a spirit of creativity.
Elizabeth Woodcock is the founder and principal of Woodcock & Associates. She has focused on medical practice operations and revenue cycle management for more than 25 years. She has led educational sessions for a multitude of national professional associations and specialty societies, and consulted for clients as diverse as a solo orthopaedic surgeon in rural Georgia to the Mayo Clinic. She is author or co-author of 17 best-selling practice management books, to include Mastering Patient Flow and The Physician Billing Process: Avoiding Potholes in the Road to Getting Paid. Elizabeth is a Fellow in the American College of Medical Practice Executives and a Certified Professional Coder. In addition to a Bachelor of Arts from Duke University, she completed a Master of Business Administration in healthcare management from The Wharton School of Business of the University of Pennsylvania. She is currently a doctoral student at the Bloomberg School of Public Health of Johns Hopkins University.
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