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Hello everybody. Welcome to Growth Without Risk, brought to you by ChiroSecure. I have been using ChiroSecure now since I graduated in 1989, so I have been a Lifetime chiropractic member. I love ChiroSecure. I feel great about their product and our services and I think everything is so awesome about what they do, especially giving you information like, this to me is the most exciting thing because to do practice without risk and to do all the other things they do with Dr. Monica Berger and Eric, Dr. Eric Quie. Unbelievable stuff. Great service. So let’s talk to you today about something that I think you may never have heard of before, and it’s something called Lean six Sigma.
I’ll say it again. Lean Six Sigma. Let’s start with the slides. And what you’ll see with Lean Six Sigma is it’s something completely different. It’s a different way to think about things, to think about your business, to think about are you efficient in your business or not? So let me just ki give you a little story of how this all happened.
Bunch of years ago, about 10 years ago or so, I was reading amazing book by Dr. Steven Covey. You probably know Steven Covey’s Seven Habits of Highly Effective People. So I was reading his last book before he passed. The third alternative. Unbelievable. If you haven’t read that book go there, go right now on Amazon, go to the library, do something Apple books and get this book cuz it’s a profoundly impactful book.
In that book he mentioned this other book called Continuous Quality Improvement in Healthcare. And I said that’s interesting thing cause I always want to improve my office. Always make it. . And in that book it talked about this concept of something called Lean six Sigma. Now I have a couple of people who are in industry, high level execs in industry, and I’ve heard them talk about Six Sigma for.
Before as being some efficiency ratio kind of thing that Deming used when they went into Japan after World War ii. And they were trying to make like a Honda and Toyota, all these companies that were these little companies be more efficient. So I had heard about it, but I hadn’t really ever thought about using it or applying it to anything that, that we do.
But then I picked up this book called Lean six Sigma de Myst. By Jay Arthur. And the reason I picked it up, I have to be a Barnes and Noble, and there’s actually a section on chiropractic on that, in that particular book. So I said, This guy knows chiropractic. I really should, check it out and see what he says.
And this is what we’re talking about. And here’s a quote that was in the book from Emerson. There’s always a better way of doing anything. Lean Six Sigma is about eliminating waste in a busy chiropractic office, which is wait time. And I said, Wow. I never really thought about like I had this procedure.
I’ve been doing this for 20 something years. And I hadn’t really thought about can I improve this? Can I make it better? Is there a way to make it for more efficient to get what I want? I hadn’t really of put any thought to it except for moving furniture or maybe changing forms and stuff.
And certainly changing the way I examine, but it wasn’t, I didn’t think about it from the patient’s point of view. I thought about it from my point of view. And you also mentioned J Arthur does in his book the amazing book Good to Great. Good is the Enemy of the Great from Jim. The quote from Jim.
And another great book. I haven’t read that one. Good. Good to great. Another phenomenal read. Just because your five senses let you detect problems at and patterns at one level doesn’t mean that they can help you at more subtle levels. So what that means is if you’re looking at your own office and you don’t kind look at your own office flow from a patient’s point of view, then you’re really not looking at it in a way to.
So Lean Six Sigma is about a way to measure something. Measure can we be more efficient, can we measure it more effectively? And it’s the term Sigma is a standard deviation concept. So what it presented in this, and I’m extrapolating cause it talks about, it didn’t talk about offices, it talked about businesses, but like a one Sigma business or an office, you got long ways, high price, bad staff, rude doctor, right?
Nobody wants to be, go to that one. And we certainly don’t wanna epitomize that a Three Sigma office is like, I went in, I got what I wanted. All right, whatever. A Five Sigma office is an industry leader. They are very efficient, they are very effective. It’s a great overall experience.
But a Six Sigma office is one step above that. That’s like the world class team, right? That people go in and they live. They’re like, Wow. And they tell everybody they know and people come from all over the world, and that is the kinda office that I wanted. So I said, Okay, what do I have to do? So reading those book, I’ve realized that there were two things I need to do to, to measure, to accelerate the patient experience of he.
Because what Mr. Au was saying is that a faster patient flow equals a greater patient satisfaction. And that makes sense, right? If we can get them in, get them out quicker, we’ll have greater satisfaction. So there’s two measurements I came up with. It’s not in this book. I extrapolated based upon what their terminology is.
And the two measures were D two A, which I, which is door to adjustment. In other words, with a moment the person walks in the door, how long does it take for them to get from the door to the. Number two is the new patient time. And not just like, how long does it take? And overall like you put on a stopwatch and then when they leave an hour later you close it.
All the steps. Let’s measure all the steps. So this was a very interesting undertaking that I did back in 2012 with one of my former interns. And we actually wrote a paper on it and presented it at a ACC rack. Back in 2012, we had a poster and now I’m actually doing it again because I got excited.
Kinda re I kinda refound this this PowerPoint and this information and I said I wanna share this with you guys and actually gonna start measuring this in my office again. So there’s two things we’re gonna, we’re gonna talk about the values stream. Map is essentially looking at all the steps of your new patient.
So from the moment they walk in, what happens and mapping it out. And what I, what they recommend is writing it out on a, like a chart like this, which they call a value stream map. And can you eliminate any the goal is, can you eliminate anything? Is there any steps that are being duplicated, being wasted time, things that don’t have to happen?
Are there any things you can do to say, I’m gonna chop this down. They call it mua, right? Cuz this is a Japanese terminology. So MUA is waste. Is there any mua happening? Any non-value added step? And cuz what we’re doing, like I said before, is we’re focusing on the patient experience, not the doctor.
The patient experience and look at, So what you’re gonna do is take post-its right, take some post-its, and then think and you and your team get together and do. What does a new patient exam look like? They walk in and are greeted by the front desk, Post it. Number one, I’ll show you what my post-its looked like.
I have in this book here, right? It’s like this whole section of post-Its right here, right? So number one, they walk in and talk to the front desk. Number two, they get They get paperwork number three, they fill out the paperwork, et cetera, et cetera, etc. So we had all these steps and we said, Is there anything that looks that could be wasted?
So this was my new patient exam value stream for my office, right? And we used this guy’s software. He has his own software that you can. You can use for free for 30 day trial, which I think we did. I highly recommend using it cuz it’s helpful in creating this kind of thing. So what we did is we mapped out and we had this 1, 2, 3, 4, 5, 6 step process from the moment they walked in the door, these six steps, and we looked at it, we said, there’s a couple of things that we can do where this time that is, was.
So what we’ve noted is that there was a weight between the paperwork and then getting in the exam room to doing history. Then there’s another weight, and then there’s another weight at the end. Because what we used to do is at the end, I would come in the middle and then the interns would finish up and then they’d have come get me again to do like a say goodbye a thing.
We said, that’s a big waste of time. So this is what we did. You see those big X’s? Those x’s are the things we eliminated. We eliminated those wasted times. So we said instead of having that wait time between paperwork and the new patient exam, what can we do? We started giving the electronic paperwork, right?
So early on 2010, we was emailed to them. Now we have emailed to them or hand them something to start doing this. Number one and number two is all the stuff at the end where we used to, they used to wait for me to come back and then do this final close sort of thing. And this recap and stuff, I just limited that all.
So was that really do any value? It really wasn’t. So we eliminated it. And you know what that meant is we took our new patient exam from something like an hour and a half long to less than an. Now, yes, you might say an hour long exam. I’m a functional neurologist and a board certified pediatric chiropractor, so my exam is very long and lengthy.
But regardless of how long mine is, it, yours is, wouldn’t it be great to, even if you have a half hour exam, to take it to a 20 minute exam, right? To be more efficient and more effective. Look at the places where you are doing things like this that are not effective, that are not value added, that are moved to M U D A that are wasted time and let’s get rid of.
And then we looked at our adjustment times and we mapped it out and they call this a spaghetti diagram. Which is the travel that the doctor and the intern have to, or the interns and the patients have to take to deal with those particular patients and draw arrows to find these patient movements.
And was there wasted movement? Was there wasted time? And how do we change that? So here’s what we did. We actually changed our entire office setup We had our setup with closed rooms and closed areas before, and we just knocked everything down and changed everything so that before they used to come in, go to the front desk and sit down, and they have to go to a room and then go to the front desk and they come back, right?
That was just all these, it’s 10 different steps for them to take. Now they walk in, they check into the front desk, or now we even have a mobile app that they could check in before they even come. Office, they’re already checked in. They come in, they sit down for X amount of time, they come, they get adjusted and they leave.
So even just changing the office setup was a huge efficiency change. But we started actually measuring instead of just that, how long did it take for them to see me or one of the interns? Or if you have associates, instead of interns, the associates. Obviously there’ll be more demand for the main doctor.
So we had an average wait time. We measured this for several weeks. We had an average wait time for me, it was 15 minutes, and an average wait time for the interns was like, I think four and seven minutes or so after we played with this and said, Where are the wasted pieces of time? What’s happening here?
What could we do? We realized that there were more patients that the interns can adjust. There’s other things that staff can get done quicker. So what we. We took things down from 15 minute wait time for me to seven minute wait time for me and for four to six minutes for the interns to, not even a minute to like maybe three or two or three minutes for the interns.
Huge change, right? And time is money because this is, if you think about, there’s like a vacuum, right? It’s like the theory of a vacuum. If you ch take this time out right now, you have more time to see more patients. And what happens is, especially if you’re the right mindset the abundance mindset, you take away the those that, that extra time and it’s gonna fill up with other patients.
And that’s exactly what it did. So we actually got way busier by improving that. Four, six minutes. We had a massive increase in our patient flow, which was very rewarding because now we’re seeing more new patients and we’re seeing more existing patients than ever before. Like the pandemic actually has been this huge change for us in a positive way because what we did is we compressed a lot of things, a lot of our time, so that we’re way more efficient.
And I think that’s, It. It was an amazing education experience to do Lean Six Sigma and then to have this pandemic and to see how we can get even more efficient with our time. So in conclusion, the Lean Six Sigma is about accelerating patient flow isn’t about making doctors interns faster. I’m about saying, Alright, let me have a quicker adjustment and skip things.
No. It’s about focusing on speeding up the patient flow. What can we do to make patient flow better and more efficient? What can we do to reduce delays between steps in patient care? That’ll actually give the doctor more time with patients because now you can focus on them and not have to worry about all these backup.
I know how it is. Docs when you’re sitting there and you gotta waiting through like we just did Halloween, Oh my Lord. Between, I hope you had an amazing Halloween like we did. We just had a crazy three Halloween, three day Halloween. People were waiting quite a bit and that’s why I’ve, I said, I brought this back up, like we really need to make this more efficient.
Now, obviously we had everybody in costumes and we’re taking pictures, and I know that was a big issue of the flow, but I think we can make our flow even. And that’s what we wanna do. Many of you guys may not know, but I hope you guys join me with I cpa. I speak I speak of something called enhancing pediatric neuroplasticity, which is really how to take care of those special needs neuro diversion populations.
And I also just recently did a tongue tie pediatric midline defect seminar. If you check that. You can get to that website. I also did back in May of this past year I did a great seminar with Dr. Steven Porsches, the founder and developer of the Polyvagal theory that I call pediatric polyvagal informed pediatric chiropractic.
If you’re interested in learning about how to take care of kids in that special way to really understand the safety concerns and how to minimize. A kid who’s near the virgin and their mindset, check this out. And I have a podcast I dunno if you guys know that, but it’s called ChiroSecure Cast.
It is the longest, at least as far as I know, the longest running podcast in chiropractic. I just published today. I published every Tuesday by 481st episode. So I love to hear you see you, You’re listening to it. Let me know what you think. Above all else, the most important thing, like our like ending is to say, Protect our future.
Adjust more kiddos. And my whole thing about what I’ve been doing the whole year for Car Secure is to be disruptive to something that I have called disruptive pediatrics. We have to be disruptive, and I think that the Lean Six Sigma concept, the Lean Six Sigma concept that you can see here, this is the book by Jay author.
The Lean six Sigma concept, I think is critical for us because it. Takes us to the next level of improving our patient care. So even if you never read this book, although I suggest you do even never read, but just do the value added map and do the spaghetti diagram for your regular patient care and the value added map for your new patients.
And then tell me what you find. I’d be really intrigued to hear what you find. You could always email me@rubenchiropracticgmail.com. I would love to know what you thought about this. Thank you guys so much. I love ChiroSecure. I really appreciate ChiroSecure. To me, there’s no better company out there than ChiroSecure.
Thank you. Growth Without Risk for having me here. Next week, we have attorney Mike Miscoe, who is another great person to help us, which is talking about value added. Think of all these value added things that ChiroSecure does. Check out what he does. Thank you guys so much and I’ll see you next time.