When he signed up for a course on operations while enrolled in the Business of Medicine Physician MBA Program at the Kelley School of Business, ophthalmologist Tom Ciulla, MD, MBA’15, was skeptical. He imagined being taught more efficient ways to make widgets in a factory.
“On its face, operations could seem quite dry and inapplicable to my everyday work,” he said.
But during the course taught by Mohan V. Tatikonda, professor of operations management, Dr. Ciulla was tasked with creating a practical project to reduce waste and enhance patient experiences in his Midwest Eye Institute practice. He teamed up with fellow physician MBAs to undertake an important initiative: reduce wait times for patients in his clinic.
Under the supervision of Tatikonda, Dr. Ciulla employed Lean Six Sigma process-improvement approaches to achieve this ambitious goal.
“Often in a clinic, there’s a lot of motion and time waste—such as staff traveling multiple times across the clinic and patients waiting. Our goal was to examine and address some of this waste and variability, which slows down the process and creates a ripple effect throughout the rest of the clinic,” explained Dr. Ciulla.
Dr. Ciulla says these benefits are “especially enormous when considered in the aggregate.”
His clinic schedule of 40 patients per day translates to about 10,000 patient visits a year. Patients will save more than 3,000 hours a year from the improvements.
Dr. Ciulla adds, “If similar approaches are implemented across entire healthcare systems, the benefits aggregate even further, achieving the holy grail of improved healthcare delivery and satisfaction at little marginal cost.”
Dr. Ciulla recently published his findings in Retina, one of the foremost peer-reviewed journals within ophthalmology.
“While this project is a textbook example from a manufacturing standpoint, it delivers new knowledge in Dr. Ciulla’s discipline and some other healthcare areas,” said Tatikonda. “That’s one reason this paper was accepted at such a prominent journal. Dr. Ciulla showed healthcare delivery can be improved—and significantly—without major expense.”
The paper was out-of-the-box for the journal, too, said Dr. Ciulla.
“The journal hasn’t published a paper like this before. Typically, it features traditional clinical or basic science research papers,” he explained. “But our study is being published because it’s both novel and has replicative value—not just for retina or ophthalmology clinics, but any outpatient clinic. High-volume medical fields can benefit very significantly from this learning, and I think the journal editor recognizes this as a first-of-its-kind paper in my field.”
In order to define the wait-time problem, resolve the issues of procedural waste and measure success, Dr. Ciulla engaged his full staff at Midwest Eye Clinic. Not only did every team member play an active role in the project, but they became invested in its success. What’s more, Dr. Ciulla gained greater experience in physician leadership.
“What I found very interesting throughout this project: If you involve the staff and make them part of the project, they become intrinsically motivated by the improvement process,” said Dr. Ciulla. “While it’s a means for improving patient care and clinic operations, it’s also a way to better lead, manage and engage staff in a way that inspires them to take a great deal of pride in the improvement.”
Tatikonda says these projects help his physician MBA students develop a different mindset and approach to management.
“What some see as a one-time improvement project is far more than that,” he said. “This has the potential to influence the entire organizational culture. Physicians build on the experience and continue with further organizational and cultural changes. Dr. Ciulla has already taken on other changes in his clinic based on these approaches, benefiting his patients and staff and helping him gain even more physician leadership experiences.”
Both Dr. Ciulla and Tatikonda say the healthcare landscape overall is ripe for process improvement. An industry that has only recently moved to electronic records, healthcare is often seen as lagging behind other fields in business improvement and innovation—something research like this aims to remediate.
“This work would not have been possible without having enrolled in the Kelley Physician MBA program, where professors like Mohan [Tatikonda] present concepts from manufacturing to improve medicine. The Kelley faculty truly teach across disciplines,” added Ciulla.
Dr. Ciulla was among the first class of physicians in the Kelley Business of Medicine Physician MBA Program, which launched in 2013. Tatikonda says the program’s merging of business and medical minds creates a dynamic learning experience.
“We are learning together how to better diffuse these ideas, beyond the one classroom itself, so healthcare delivery can be improved everywhere,” he said.
The Retina paper is co-authored with other Kelley Physician MBA students, including cardiologist Julie Clary, MD, MBA’15, and pathologist Eyas Hattab, MD, MBA’15; clinic staff who participated in the project, including practice administrator Amanda Hill, MBA, and ophthalmology resident Rehan Hussain, MD; and improvement project coaches Yehya ElMaraghi, MBA’14, MBB, and Tatikonda, PhD, MBA, MSE.
Tatikonda says the opportunity to collaborate with experienced physicians on projects like this increases his credibility with otherwise disbelieving physicians when he encourages use of manufacturing-based process improvement models in healthcare.
“Our students help me translate this language to other physicians, making these techniques more approachable and believable and helping to hasten improvement of U.S. healthcare delivery.”