Creating a Lean Practice

Imagine a practice in which your patients get exactly what they want and need exactly when they want and need it. The quality of care you provide is demonstrably high, with no errors, no waiting and no hassles, and your office delivers all of the services rec ommended for disease management and health maintenance, as well as effective patient education. You and your staff are relaxed, and your office is calm. Your prac tice is so efficient, with overhead well below the norm, that you make a very comfortable living practicing family medicine. You are always on time for patient visits, and you are always home in time for dinner. Is this a pipe dream? Not at all. Through initiatives such as the Institute for Healthcare Improvement’s Idealized Design of the Clinical Office Practice 1 and Dartmouth-Hitchcock Medical Center’s efforts to understand clinical “microsystems,” 2 physicians all across the country are redesigning their practices to meet most or all of the elements described above. 3 (See “An example from the real world” on page 36.) In addition, the Future of Family Medicine project has issued a call for family physicians to redesign their practices around the “New Model” of family medicine, which is projected to dramatically increase a group’s income. 4