Key log and problem solving for health care practices

Neil Baum, M.D.

As a youth, I attended summer camp in Northern Wisconsin. Every Friday evening, a key log ceremony was held for the entire camp. The key log metaphor in the context of a river refers to a log that prevents the free flow of logs in a river to the lumber mill. When one log becomes stuck, a logjam prevents other logs from moving downstream. When the key log is identified and then removed or adjusted, the entire log jam can be released, allowing logs to flow freely once again. In health care, we often encounter blockages and obstructions. Often, we can identify the one element causing the problem. In that case, we can return to a practice that flows smoothly, and the patients are rewarded with a positive health care experience. This blog discusses problems or bottlenecks and how identifying the key log, or the obstruction to solves a bigger problem.

In health care, the key log metaphor highlights critical factors that, once identified and addressed, can significantly enhance the health care system's overall effectiveness, efficiency and patient outcomes.

There isn't a doctor or practice that hasn't experienced a problem or a crisis, either in patient care or in the business aspect of the medical practice. Unfortunately, doctors have few skills in crisis management or non-clinical problem-solving. This task is often left to the practice's office manager or medical director. This blog will discuss finding and releasing the log jam and how it can be applied to nearly every medical practice.

Data exchange between health care systems, providers and patients is crucial for coordinated care. For example, a patient completes demographics and insurance information, as well as an online health questionnaire, in the primary care physician's office. Then, the patient goes to the lab or imaging center within the same institution and must fill out the information entered in the PCP's office. This creates a logjam for the practice, resulting in inefficiency, decreased productivity and decreased staff morale. By addressing the key log of interoperability, health care systems can reduce errors, improve patient safety and work more efficiently.

Another example of finding and releasing the logjam is the problem of frequent delays in patients seeing physicians, which occurs in many practices. The problem to solve is why the practice is one hour delayed in seeing patients by mid-morning when the practice is supposed to start seeing patients at 9:00 AM. Answer: Patients are arriving 30-60 minutes late for their appointments.

Why are patients showing up late for their appointments? Answer: The doctor is usually 30-60 minutes late, and patients become upset waiting to be seen by a chronically late doctor. Therefore, they often arrive and check in 30-60 minutes after their designated appointment times.

Why is the doctor 30-60 minutes late by mid-morning? Answer: The doctor arrives at the clinic 30 minutes late because patients are usually not taken to the exam room until 9:30. Instead, the doctors go to their computers to check emails or return phone calls.

Why does the doctor arrive 30-60 minutes late each morning? Answer: The staff places patients in the rooms from 9:15 to 9:30 and does not prepare them for the doctor until 9:30.

Why are patients put in the rooms 30 minutes after their appointments? This is the key log causing the problem: The staff doesn't arrive until 8:30 and is not ready to place patients in the room until 9:30.

The key log removal solution is to start the day at 8:00 and begin rooming patients at 8:45. Then, inform the doctors that they must arrive in the office by 8:45, allowing them a few minutes to review their computers and that they should start seeing patients promptly at 9:00.

Why look for the key log?

Most medical practices solve problems by identifying the issue and applying a quick fix for prompt resolution. It is better to identify and remove the key log to prevent the problem from occurring again. Seeking the key log rather than using the quick fix process provides practices long-term benefits, including:

• Reduces recurrence of the same problem (by identifying the key log, the symptoms are less likely to happen again)
• Preventing problems before they occur
• Gathering information for identifying other issues that are impacting the practice
• Emphasizing quality and safety over speed

Every practice is unique, and all workplaces have their own set of problems that they need to solve. Implementing the key log concept helps medical practices better understand their issues and gives a clear roadmap to address them permanently.

Bottom Line: One of the best things about finding the key log is that it is easy to implement without added overhead expense. The only cost is the time required to go through the process.

If you have any suggestions for identifying or removing key lots, let me hear from you: doctorwhiz@gmail.com.

Neil Baum, MD, a Professor of Clinical Urology at Tulane University in New Orleans, LA. Dr. Baum is the author of several books, including the best-selling book, Marketing Your Medical Practice-Ethically, Effectively, and Economically, which has sold over 225,000 copies and has been translated into Spanish.