Get Ready For Real Change with Three Simple Questions

November 11, 2019 – Lean/Six Sigma methods (developed in the manufacturing sector) applied to improving processes in the service sector can be dramatically more effective by simply asking for input from the people who actually perform the work.

The process typically includes process mapping the As-Is workflow of problem areas, i.e. documenting how things are currently done. In medical practices for example, those problem areas are often administrative such as medical billing, front desk check-in, collections and patient scheduling.

A process map looks like a flow chart. It shows all the steps performed within a given process and who actually performs them. Populating these maps with accuracy though is key. In the old days a consultant might walk around with a clip-board and stop watch in hand, observing by “looking over the shoulders” of workers doing their day to day activity. For various operational and psychological reasons, this tactic never really generated much accuracy.

An often-over-looked approach to effectively mapping current workflow with accuracy and ultimately uncovering the hidden causes behind the workflow inefficiencies/waste is simply to ask the people doing the work, i.e. your “subject matter experts (SME’s)”.

Three simple questions is often all it takes: 

  1. What slows you down?
  2. What is a waste of your time?
  3. If you were king or queen for the day, what would you change?

With this information in hand, tremendous insight into improvement opportunities ultimately resulting in waste reduction is often gained quickly from your team of experts.  The resources of time and money freed up can then be redirected to activity that adds customer value.

In a similar project within a medical practice, (a few years before EHR), the internal project team discovered that nursing staff was consuming approximately $75,000 of their time looking for lost medical charts. Worse, critical activities were lacking such as triage and patient education. Once the root cause of the problem were understood, the As-Is process was redesigned into a new To-Be workflow and the $75,000 of nursing staff time was redirected to value-added patient care services.

You too can get started improving your workflow by asking your SME’s those three simple questions . . . and get ready for real change!

For a printable copy of this article, please click here.

For more information, please contact Ralph Jeswald at 

About the Author

Ralph M. Jeswald CPA, LSSMBB

A Partner with Dopkins & Company, LLP, Ralph’s primary responsibility is providing a unique blend of consulting and compliance services to many of the firm's clients. Ralph has developed a unique expertise in the design and implementation of custom performance management and improvement solutions primarily for service-based entities. As a certified Lean Six Sigma Master Black Belt, he has had significant experience using and teaching the Lean and DMAIC tool sets, strategic planning, activity-based cost/management, performance measurement, and other related performance improvement methodologies.


Whether you are evaluating career opportunities as an accountant, business consultant or IT professional, you'll want to know what differentiates Dopkins & Company from all the competition. Learn more today.

Learn More