Cause and effect diagram Process Staff No standard rooming process due to physician preference variations MAs support opening procedures and end of day cash reconciliation process with reception staff Walk-in visits require MA to leave current task Search for supplies in exam and stock rooms No established supply par levels Wasted motion going to printer or picking up medications, educational material or supplies Staff who arrive after 7:45 miss daily huddle High turnover increases inefficiency and training demands Disorganized medical supplies No standard process for ordering needed supplies Problem statement: Practice workflow inefficiencies decrease value-added time spent with patients Patients may not arrive at scheduled appointment time Not enough physician documentation time during clinic session to complete for all patients Patients may omit important health information during visit Cannot place lab orders for new patients until they have been established at the practice Physician schedules are configured without consideration of patient complexity Patient visit documentation requires clicking to multiple tabs First patients of morning and afternoon sessions roomed late because of pre-clinic huddle Physician prints, staples and reviews after visit summary Some patients may not want to disclose the reason for the visit over the phone Documentation Patient Red text: causes of inefficiency that can be controlled and improved. Black text: influences that are more difficult to control. Source: AMA. Practice transformation series: starting lean healthcare. 2015. Copyright 2015 American Medical Association. All rights reserved.