I believe that the best healthcare sites are run like the best businesses. Each person has the time to do a good job. Each has a chance to be heard and contribute to a quality service and product. Each has a decent income that he/she deserves. I believe that if these are present, then patient health and satisfaction will be optimal and providers will be happier.It seems that it is especially becoming harder to find these characteristics in the primary care physician’s office. A front-page article of the March 3, 2007 issue of the Wall Street Journal illustrated some of the results of the disappearance of these traits in the primary care office. Dr. Gordon Moore was describing how he was forced to see on average 30 patients a day for at most 15 minutes a patient. He went on to detail how this led to errors in prescriptions and ultimately to how unhappy he was. His solution was to start a solo, high-tech practice in which he was much happier and in which the patient health and satisfaction greatly improved.The article pointed out that the mean income of family care physicians has dropped 10% in the past eight years while specialists’ income has remained stable. The confluence of these trends has not only been a decline in patient and physician satisfaction but also a decline in the numbers of physicians entering into primary care. In the rest of the industrialized world about one-half of all new doctors become primary care physicians; in the U.S. only about one-third do (these trends are documented in surveys of the American Academy of Family Physicians). This trend directly impacts the cost of health care; other industrialized countries spend far less per patient and achieve the same results as the U.S.Perhaps this gloomy picture sounds like your site. Can anything be done? I believe so. One approach is to apply the tools of lean manufacturing. For instance, I read of one site where the physicians were told to significantly increase the number of patients they saw each day or else the business would lose money, as in Dr. Moore’s case above. The managers of the practice did not even think of looking at other problems in the office to see if savings could be found without increasing pressures on the physicians. In this same office patient records were scattered in three different places. A great savings could be achieved if the office centralized these records and more could be achieved if the records were digitized. I am sure that other examples of eliminating waste in effort, a key element of lean thinking, could be found in this office if management explored a bit further. For instance, if they decreased the number of billing errors by 50% or more, significant savings could be achieved. Time could be saved during physician exams if the location of equipment and supplies in the examining room were standardized and if supplies were constantly replenished. This is an example of a clean an organized workspace in the lean environment. My point is that many efficiencies could be found in a primary care office other than by pressuring physicians to speed things up.What is a good way to find such opportunities for improvement in the office workspace? You should definitely involve representatives from each area or specialty in the office-nurses, physicians, managers, coders, etc. You might want to try a “kaizen” event-a gathering of such representatives over a short period to brainstorm ideas for improvement and ways to implement and measure agreed upon changes. I wouldn’t worry that you might not know how to correctly conduct a “kaizen” event. Rather conduct a meeting that fits the personnel of your site and which results in good ideas and support from all your representatives. If you implement the suggested changes and measure outcomes such as satisfaction of patients and personnel, profit, and patient health I am sure that you will find all have improved.New models for primary care are emerging too. Besides the solo practice mentioned above, the March 13, 2007 edition of the Wall Street Journal detailed a model developed by Dr. Michael Kaplan of New York. He focuses on managing weight-loss for the obese, rather than having bariatric surgery. Patients pay for the service out of pocket. He estimates that a practice which devotes itself exclusively to this would earn an extra $100,000 to $300,000 each year. He goes on to state that a physician group could use his approach for select clients while still treating the normal population of clients and thus significantly increase income for the practice. Perhaps this model could also include tobacco cessation and make similar profits. If so, such practices could dramatically reduce factors which have significant impacts on patient health.I hope that I have convinced you that there are significant opportunities to improve the primary care practice without having negative consequences. Look for ways to cut inefficiencies without having providers rush through exams and experiment with new models. You will surely be rewarded in many ways.