INDIANAPOLIS  —  A Kelley School of Business Physician MBA graduate and urologist is working to significantly decrease patient wait time at the Indianapolis VA urology clinic.

Tom Gardner, MD, MBA’17, urologist at the Richard L. Roudebush VA Medical Center, is using skills learned in the Kelley Business of Medicine Physician MBA Program to add to the process improvement program already in place at the Indianapolis VA hospital.

“Our patients are veterans. They’ve fought for our freedom; they’ve gone to war for us and have served our country selflessly. We owe it to them to provide a high quality service and the least amount of wait time,” said Gardner.

This journey started when, during a class project for the Physician MBA, Gardner realized a routine procedure that takes about 15 to 20 minutes to complete was taking, on average, about 100 minutes of a patient’s day: from the moment he walked into the clinic to the moment he left.

Dr. Gardner and his team used Lean/Six Sigma system redesign techniques, which is a process improvement methodology aimed at reducing defects and waste, to get patients in and out – efficiently – while maintaining the same quality of care. Dr. Gardner was able to leverage these methods because of a culture of Lean system redesign initiated by assistant director Dr. Imtiaz Munshi about six years ago at the VA.

“You can make unbelievable differences with fairly small changes,” said Gardner. “All the pieces of the puzzle are there; it’s just a matter of shuffling them up and making them fit together a little bit differently than they do now.”

The team at the urology clinic met with nurses, administrators, assistants – everyone who plays even the smallest role in a patient’s time at the clinic.

By identifying steps in the process they could change or eliminate, the team was able to reduce the procedure time from an average of 100 minutes to 29 minutes. They also used Lean Six Sigma techniques and theories learned in Gardner’s Kelley Physician MBA courses to reduce patient wait times in the clinic, which accounted for a significant drop in a patient’s overall procedure time. Finally, Gardner’s team reduced the time it takes for patients to be seen for the procedure: Instead of waiting an average of 38 days for the procedure, they’re now waiting 17.

Gardner points out process improvement isn’t just about saving money, but about making the quality of patient care better by making it more efficient.

“We now are reviewing and examining every process we have, to ensure each is effectively streamlined and efficient. By the time we’re done, we hope every aspect of our urology clinic will be as efficient as possible,” added Gardner. “Quality is number one. There’s no reason why you can’t have quality along with efficiency, cost-effectiveness and respect for peoples’ time. If you can do that, you’ve made a difference.”

“Just by looking at this one procedure, the cystoscopy, the cost savings are in the order of anywhere from $3.5M to $5M a year,” explained Gardner. “That’s a low estimate. A high estimate could be $8M to $10M in savings a year. And that’s just this one VA hospital — This one small urology clinic: unbelievable savings.”

“The work Dr. Gardner is doing with his team at the VA hospital and with his colleagues in the Physician MBA Program is incredibly important, and it will help all VA stakeholders. That means patients, patients’ families, physicians, nurses, techs, taxpayers – everyone. Stress will go down, and satisfaction will go up,” said Mohan Tatikonda, professor of operations management at the Kelley School of Business and one of a handful of experts in the country who studies enterprise-level Six Sigma programs. Professor Tatikonda served as an advisor to Gardner during this project.

This is a big reason why many of our physicians enroll in Kelley’s physician-only MBA program. They want to make positive changes in healthcare,” said Tatikonda. “They come in with ideas, but they know they need to know more in order to implement them. With the right business knowledge and skills, they can lead changes and interact with non-physician and physician executives who have management training on the same level.”

“This is why I joined the Kelley Business of Medicine Physician MBA Program. I knew this was possible; I just needed the tools and knowledge to do it. Understanding processes, finance and leadership are all imperative to providing better service for our patients,” said Gardner.

Kelley Physician MBA students are learning skills beyond the medical science of taking care of a patient. They’re learning how the healthcare system will deliver that healthcare to patients by studying finance, accounting, marketing, leadership and Lean Six Sigma. When applied to healthcare, Lean Six Sigma process improvement can mean preventing medical errors, increasing quality of care and outcomes, reducing lengths of stay and improving patient (and clinician) satisfaction. Physician students can earn a Green Belt certification during the Kelley Physician MBA Program.

The Roudebush VA Medical Center has a pilot program right now, implementing Lean Six Sigma concepts to encourage process improvement. The urology clinic is taking it one step further, looking over all processes.

“Roudebush has what many believe is the best improvement program of any VA hospital,” said Tatikonda. “Over the last 10 years or so, this VA hospital has put in Lean operations, Lean improvement ideas and other continuous improvement ideas.”

Gardner and his Physician MBA classmates also worked with Tatikonda on a project to improve timely care of veterans with a cancer diagnosis. This project led to the redesign of the clinic’s scheduling process and submission process for patient consults.

“As physician leaders, our students can make a big difference in the management of individual projects,” Tatikonda said. “Process improvement is where the rubber meets the road. Our physician MBAs are leading the changes they want to make. And they’re seeing magnificent results.”

“Realizing process improvement doesn’t just happen; it takes teams from different departments working together. This is leadership in the best way,” added Tatikonda. “Many of these improvements can be applied at other hospitals. The VA is a national system. When we see changes in improvements or best practices, this can be shared and spread across the system.”

By: Teresa Mackin, tmackin@iu.edu, 317-274-2233