Web Check-In: Lean or Not?

My kids have all had it and most recently my wife got it. I, knocking on wood, have escaped it so far but I am not getting cocky about it!

In any event, at one point last week 2 of my 4 kids were sick along with my wife. So we called our pediatrician for the kids and our family doctor for my wife.

My experience with the pediatrician was less than exemplary… but I’ll save that story for another time. The thing I want to explore in this article was the process we used to get my wife in front of a doctor.

Our family doctor was not able to see my wife on the day we called… and since she was feeling REAL bad we decided on the ‘Doc in a Box’ known as Care Now.

I remembered seeing a commercial about a web check-in process for Care Now. So I decided to give it a shot. I got to their website and in just a few clicks was booking my wife’s appointment. I entered in all the insurance details and other stuff meaning she would not have to do this in the office.

A few minutes later I was done. The confirmation page said they would call when it was time for my wife to come in. They asked how long the commute was which I’m assuming they took into consideration.

About 40 minutes after submitting the form they called for my wife to come in, meaning she got to ‘wait’ in the comfort of our home and not some germ filled waiting room.

And while she still had to wait a few minutes once she got there it seemed to be much better than her having to go there and fill out all kinds of paperwork and then wait even longer.

So, I’m curious, do you think this web check-in process is lean? Or are they treating – no puns intended – the symptoms and not the problems of poor internal processes that create the waiting in the first place? What do you think?

N K Law
March 9, 2009 - 6:23 am
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An efficient ‘web check-in and call-in’ process is lean in a good sense. The doctors’ office is addressing a customer value point — time and comfort. While it would be terrific if doctors could see every sick patient quickly and without delays upon arrival, there is no realistic way to get rid of variation in time that each doctor applies to address different acuity and severity symptoms of patients. If only more service providers used such methods, there would be much less frustration by their customer base.
Brian Buck
March 9, 2009 - 8:26 am
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I think it is Lean:

1) Sounds like this was value added to you as a customer. Even if online was a way to cover ineffeciencies, it might be argued that filling out the insurance forms from home is still better than the uncomfy chairs

2) Lessens the chance for medication errors if the patient can’t remember the name or dosage of what they are currently taking when asked away from home

3) Reduction in patient wait time is Lean

4) I assume this process reduces inventory or WIP waiting around in a waiting room. Perhaps the saved waiting room space was able to be changed to another exam room.
Mindo
March 9, 2009 - 11:03 am
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From your text I can’t really say if it is leaner or not.

There may be some cost savings in duplicate work (you hand-write the form and someone else enters it into their computer), and hopefully some of that goes directly to the patient.

But unless there is data that shows that on averate patients had to wait lesser, I can’t say if it was lean. Sure, waiting at home is a lot better. But just because I got to wait at the executive lounge for a delayed flight does not make the _process_ leaner.
Tom Palmitesta
March 9, 2009 - 12:22 pm
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Just today I had to visit the family doctor (my eyes are getting worse for reading too many blogs). Yesterday I entered the local Social Security web page, gave my ID number, saw my family doctor’s schedule, and made an appointment. Total: less than 5 minutes. Today I arrived at 11:30 a.m., but the supposed 6 minutes per patient (yes 6 minutes takt time is what a family doctor is allowed in Spain’s social security) stretched to more than one hour (there was a queue of 4 before me) because one of the patient needed more than half hour. So, I believe that making appointments via internet or phone is OK for the patient, but it is not lean. The medical center should find a way to balance the line by separating patients by degree of attention needed. But can you do that by phone or over the internet? Probably not.
John Hunter
March 9, 2009 - 2:24 pm
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I would say lean. Not perfect, but that is one of the concepts lean understands, you need to continually improve. To me this is a move in the right direction. If it prevented further improvement (they were satisfied with, as you point out, a system that has waste but have found a way to reduce the impact on the customer) then the action would not be lean.

But I think in general you will have many improvement that are far from the ideal improvement in practice. I think taking positive steps is good. But I do also think often people accept small improvements when many possible improvements are left undone. Which is a problem.
Trish
March 10, 2009 - 4:19 pm
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I would agree with Brian. But my request is this: May I use this article to kick off a Rapid Improvement Event. To get people thinking lean. For some military people they need a little nudge.
Ron Pereira
March 10, 2009 - 7:22 pm
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Hi Trish, yes, it’s no problem to use any LSS Academy article. I also wrote a whole series on kaizen… which may be beneficial as well.

https://blog.gembaacademy.com/2007/07/26/kaizen-rules-%E2%80%93-9-10/
M B
March 11, 2009 - 5:28 pm
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Here is a related article – for Emergency Rooms. There are many comments, as well, pointing out some potential problems with the model.

http://www.cbc.ca/canada/manitoba/story/2009/03/10/mb-virtual-er.html?ref=rss
Mark Graban
March 15, 2009 - 3:40 pm
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As much as I love “lean” principles and thinking, we shouldn’t get too hung up on whether it fits definitions of “lean” or not.

Is it better for the patient? Yes. Others are right that the ideal is no waiting, but I’d much rather wait at home than in a waiting room picking up other people’s germs (or spreading mine). I’d just hope the arrival time you’re given is accurate.

I hate filling out forms long hand in an office. Again, I’d much rather fill out a form online (using Google Toolbar auto fill for some data) and not make someone repeat the work (or risk typing something in wrong). In a way, this is bad to offload work to customers, but if the value in return (not waiting in the WR) is worthwhile, then I wouldn’t complain.

Is this good for the MDs? Maybe. They are probably still highly utilized the same way if patients were queued up in the WR. It could be better for the business if less front-desk staff are needed and patient satisfaction is higher.

Ron, glad you pointed this out. If I ever need services like this in the future, I’ll go there instead of the similar place over in Southlake (this other one is closer and I didn’t know it was there).

Is it Lean? Maybe, sort of? In a way, who cares… it sounds better and we shouldn’t let perfect get in the way of better.
GH
March 28, 2011 - 9:12 am
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I haven’t been to Care Now and generally visit Complete Med Care when I need a quick doctor’s visit. They have an online registration form that can be printed out and filled out at home, but you still need to take it in to the office once it’s been completed. CareNow’s online registration process is a definite plus and I, like others, do not like the potential of spreading germs while in a waiting room. Due to their ‘lean’ online process, I’ll probably consider them for future visits.