Kelley Physician MBA grad improving patient wait time at Indianapolis VA hospital

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.

Watch Dr. Gardner's Story

“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.

CLOCKWISE FROM TOP LEFT: Dr. Gardner meets with a patient at the Indianapolis VA, Professor Mohan Tatikonda works with the team at the VA to discuss Lean Six Sigma projects, and the team works at the VA to look over all processes within the urology 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.”

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.

Mohan Tatikonda, professor of operations management

"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.

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.

Tom Gardner, MD, MBA'17