Learning about Lean Healthcare at APTA CSM 2013

We’re just back from the American Physical Therapy society Combined Sessions meeting in San Diego. How lovely, you say, San Diego in January. We think it was lovely but we spent most of the time in the convention center meeting people, and soaking up all kinds of information. Over the next few blog posts, we’ll go into detail about a few of the sessions.

One of the most interesting, was Lean Physical Therapy presented by Proaxis Therapy, a 20 location organization serving South Carolina and Colorado. Team members from Proaxis had completed the Belmont University Lean Healthcare certificate, and were sharing how they used these practices in improving their organization. Lean Healthcare comes from Toyota’s famous Lean Manufacturing philosophy. Wellpepper is following Lean Startup techniques so we were extremely interested to see how this could be applied to healthcare. Lean philosophy looks at eliminating wasteful efforts and continual improvement.

Lean Healthcare Observation sheet

Lean Healthcare Observation sheet

The session started with a video of a physical therapist at a Proaxis clinic running around trying to start a session with a patient, looking for equipment, trying to find gloves that fit, and muttering under her breath. The patient, meanwhile, was waiting on the table. A great thing about this session is that it was interactive, and we used this video to start our own lean training, first by practicing the art of observation. We broke into groups and watched the video again, focusing on observing waste. We tracked how many steps she took (120-150), how long it took before she got back to the patient (almost 5 minutes), what activities she did (see image), and how many times she retraced her steps (a lot).

Proaxis had done the same observational activity, and talked about how they used it to cut waste: organize supplies better, make each PT accountable for all the supplies, and completely reorganized the clinic layout based on user tasks.

From a software perspective, it was pretty fun to experience this type of usability study in the physical world.


Lean Healthcare Value Map for hand washing

Next we learned about value stream mapping: breaking down an activity into it’s component tasks, and looking for tasks that are waste, versus tasks that add value for the customer. (All of lean is focused on adding value to the customer.) Here’s a value chain for hand washing. You might not think of this as a valuable task, but it keeps everyone healthy.

In this value chain, not being able to turn the water on is waste. There are other potential areas for waste, for example, maybe the soap or paper towels are empty. All of these take value away from the patient, and frustrate the caregiver.

Again, we practiced this by trying to map out the value stream for what seemed like a simple task: patient cancelling an appointment. Our small group very quickly realized that there are no simple tasks as we got into a complex decision tree about whether this was a chronic canceler or an isolated incident.

Our value map became quite messy.

Lean Healthcare Value Map Exercise

Lean Healthcare Value Map Exercise

Next step was to ask the 5 Whys, a series of 5 questions designed to get to the root cause of an issue. We figured out that the root cause on this problem was wanting to make sure that physical therapists were being as productive as possible, and scheduling was a key part of this. Although, at this stage you’re not supposed to problem solve, our little group discussed briefly how airlines solve this type of problem by overbooking.

When we came back together as a full group, Proaxis Therapy shared a few case studies on how they had implemented these techniques in their clinics in two key areas: reception/registration, and documentation.

Lean Healthcare Case Study Results

Lean Healthcare Case Study Results

The results were pretty amazing, especially in the area of documentation, saving physical therapists 2 weeks a year, and they had feedback that could really improve their EMR system. For lean software companies, having a user do this type of analysis would be invaluable.

This blog post only scratches the surface of the session, and presenters Sean Mc Enroe, Robbie Leonard, Nicole Kluckhohn, and Shannon Irish reminded us that they were distilling a 5-day course and months of work into 2 hours. They did a great job of it!

Posted in: Lean Healthcare

Leave a Comment (2) ↓


  1. Schoeffler July 27, 2016

    Do you have similar lean mapping for dental offices

  2. Anne Weiler July 31, 2016

    We don’t but if you do a quick search, there seem to be solutions out there.

Leave a Comment