The P.U.R.R.fect hospital patient flow

You can improve outcomes by utilizing lean process techniques to optimize the way a patient moves through your hospital.

The P.U.R.R.fect hospital patient flow
To create a successful and highly efficient patient flow, zero in on each part of the process.

Moving a patient through a veterinary hospital is a complex activity involving many opportunities to make minor improvements that would result in better outcomes for the hospital, patient and client. Lean processes are those that have been analyzed and refined to maximize efficiencies, experiences, accuracy and financial outcomes. Utilizing studies of lean process techniques, I designed a solution that will help your hospital’s flow reach perfection — or put another way, P.U.R.R.fection.

For the purpose of explanation, I will analyze patient flow for a routine surgical procedure. I will look at the process from check-in to same-day checkout.

P.U.R.R. breaks a process down into:

  • P: Process part mapping
  • U: Understanding each part
  • R: Refining each part
  • R: Reaching results in each part

(P) Process Part Mapping

The first step in improving patient flow is creating a map for each part of the process. In the graphic below, the flow for a routine surgery starts with the front-office check-in and moves on to the technician, veterinarian, procedure and six other steps. Creating a process map helps you to visualize how team members interact along the way.

patient flow


(U) Understanding Each Part

The next step in creating a successful and highly efficient patient flow is to begin to deeply understand each part of the process. For the purpose of this demonstration, I will zero in on the first step, the check-in, which involves staffing, forms, legal considerations, protocols, financial needs, client service, accuracy, time and, finally, handoff. To create a complete process map, the exercise is done for each step.

Here is a breakdown of the first part, check-in:


  • How many staff members are needed to execute the front office check-in?
  • For the number of procedures your hospital performs, do you need more than one staff member at check-in?


  • Which forms will be filled out at check-in by the staff and the client?
  • Which parts of the form are self-service and which require someone to ask questions of the client?


  • Will any legal paperwork or release forms be included in the check-in portion of the process?
  • What legal considerations are associated with a routine surgical procedure?


  • Do we have a written hospital protocol for the check-in process?
  • Do we have the resources, equipment and inventory to support the protocol?


  • Will any financial conversations or presentation of treatment plans occur during the front desk check-in?
  • Will payment methods or deposits for procedures be discussed during the front desk check-in?


  • Is the front desk check-in a good client experience?
  • Will the front desk check-in lend to a five-star result when combined with other aspects of the process part map?


  • What is the percentage of complete and accurate (%C&A) associated to the front desk check-in?
  • Does paper or digital recordkeeping increase the %C&A?


  • What is the average time taken to complete the front desk check-in process?
  • When combined with other aspects of the process map of patient check-in, what is the total time needed to check in the client?


  • Is the handoff to the next staff member involved in the check-in process smooth and consistent?
  • Does the integrity of communication, accuracy and service remain high during the handoff between staff members at check-in?

(R) Refining Each Part

Once you have a granular understanding of each part of your process part map, it’s time to refine those details to create a better overall process. The refining is ongoing and should be revisited regularly. When you are making adjustments, consider three factors:

  • What can I immediately change to have the biggest impact on time?
  • What can I immediately change to have the biggest impact on service?
  • What can I immediately change to have the biggest impact on patient safety?

As you look at all parts of your process map, choose one in each of the categories below that you and your team can immediately impact. This high-level analysis of all your processes will create the first 30-day plan for improving the process.

patient flow

Here is what those identifications might look like for a typical surgical patient process flow:


  • Part: Front office check-in
  • Focus within the part: forms


  • Part: Procedure
  • Focus within the part: Monitoring protocol and associated forms


  • Part: Patient release
  • Focus within the part: technician-client education at release

What’s important as you begin to adjust processes is to not choose too many items to change at once. A 30-day timeframe is suggested to give 100% attention to the identified items. To continue to make incremental improvements, repeat the refinement selection step to choose new three components to improve during each 30-day period. Before you begin each period of process improvement for the identified items, discuss how you will measure results. During process improvement, you need to understand what constitutes a success or a failure.

(R) Reaching Results in Each Part

Positive results are the goal of every effort to improve both the whole and granular aspects of a process. In the refinement step, you will have discussed and agree on how to analyze the success or failure of your process improvement efforts. In this step of process improvement, you are analyzing the results of your efforts.

The table above is an example of what the results analysis looks like for a 30-day cycle of process improvement, using the example given in the previous step.

A Leader’s Role in Process Improvement

Building the P.U.R.R.fect process flow is a team effort that is heightened by active positive collaboration among the team members. As a leader, your role in process improvement is to be a facilitator of the exchange of open communication about potential improvements. Including team members in the analysis of process flow improvement will have a positive effect on their acceptance of the change associated to improvement. It also will increase the amount of intellectual contribution to the improvement of hospital processes.

Allowing your team to collaborate on process improvement will allow you to identify both subject matter experts and team members who should be considered for advancement within the hospital.

Getting Started

To begin with process flow improvement, choose the process you think will have the highest impact on overall hospital performance. Considerations might include a typical wellness visit, a routine anesthetic procedure, boarding or grooming processes, or prescription refills. Once you have identified the process you feel will have the highest impact, begin to build the P.U.R.R.fect flow for that process by identifying the parts.

Create a digital or physical chart that your team can interact with. Include the different aspect of the process and analysis of the parts into your staff meetings to creative a collaborative culture around process improvement. As a leader, your role is to frame process improvement as a positive part of the hospital environment.

Always Be Improving

Process improvement is a continuous process that should become a part of your hospital culture. As a leader, you need to coach your team to be an active part of collaboration, process improvement and innovations that support a healthy customer, staff and patient experience.

Building a P.U.R.R.fect patient flow requires a leader who understands the power of a positive culture, team collaboration and the utilization of process improvement techniques.

Claire Pickens is national senior director of operations for Thrive Affordable Vet Care, a former practice owner and a veterinary management professional. She is Fear Free certified.

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