Now more than ever, the HME mantra needs to be lean. Whether you are in a Metropolitan Statistical Area or not, or won a bid for round one or not—your HME can use the tools of lean processing and significantly impact the way you do business.

Lean is not a manufacturing technique. Lean is process-focused and can improve operations, reduce waste, open bottlenecks, and boost flow for your HME business. Lean has its own language, terms, and definitions. It is a proven methodology that works. I believe in simplicity and completely understand that the day to day operation of an HME does not lend itself well to overly complicated systems, but rather thrives on action and measurable outcomes to improve the overall culture and business.

The three terms we will review are change agent, error proofing, and the Five S's. This embodies the core essentials of lean as it will apply to your HME.

A change agent is the most valuable player in the lean process. The change agent is the person who will lead the company from the traditional operational mentality to becoming a lean organization. This person may come from within or outside the company. This person, while working with leadership, is empowered to assist in the development and implementation of lean processes throughout the organization.

The change agent should possess a passion for the business and can look outside the box for solutions. A keen sense of workflow will aid the change agent as they will certainly implement ways to improve efficiencies from the inside out. The change agent must realize that being lean requires top down and bottom up adoption. Selecting and educating the change agent is the first step in becoming lean.

Error proofing, which is also called mistake proofing, is a system that addresses both the product and the processes to detect errors before they become defects. These are critical measuring points within a process that will allow us to identify errors early.

A perfect example of error proofing in an HME is found in the intake and customer service area. Strategically placing a quality assurance or quality control step in your intake process will drastically eliminate errors that cause increased DSO, problem accounts, errors in diagnosis codes, billing codes, and the like. These all are elements of the intake and customer service process that must not go undetected.

The QA/QC component is the verification process that checks and measures these areas before they become a problem. Placed strategically before the billing process, customer service team members are held accountable for information received and inputted into the system. If defects are identified at this stage, they are sent back to the team member for correction. Using this process as a training tool for customer service is a valuable asset and will increase knowledge and awareness for all of the team members.

Some HME software programs allow you to run reports to track held orders or unconfirmed orders, which is an excellent measuring tool at this point in the process. The Five S's method of workplace organization and visual controls is a proven system that improves efficiency. The Five S's are: 1) sort; 2) set in order; 3) shine; 4) standardize; and 5) sustain.

Due to its simple nature, the 5S methodology may be applied to nearly any workplace in a short period of time. The 5S methodology can be applied in customer service, intake, delivery, billing, sales, and many more areas within an HME. However, every organization has specific needs that may require changes in how 5S is implemented.

The first S—sort—calls for the elimination of unnecessary items in a work area. As debris and unused objects build up, productivity decreases.

Set in order focuses on effective storage and organization with a goal of developing an environment that increases long-term productivity. This is where identical workstations really begin to take shape.

The use of bins in a workstation is one of my favorite tools to use at this stage. Having a process flow that is sorted and then set in order only makes the workstation more efficient. Remember, we are not taking away individuality but instead reinforcing the HME process flow. The individual team member can have pictures and posters (as per company policy), but when it comes to the process flow of work, it is set in order.

To shine, the work area needs to be maintained and kept clean. Dirty work places tend to be a distraction and faults can be hidden or go unnoticed. A clean workplace will improve morale, health, and safety. However, don't be fooled into thinking that a clean work area will solve all your DSO, unconfirmed order, and held order problems. If you have people who are not properly trained, a workstation designed and maintained by Martha Stewart will not help.

Ty Bello

To standardize our process will assure procedures are followed and ultimately it will be self-perpetuating. The involvement of your team at this point is essential for the overall success of each process. This will increase buy-in across the board.

To sustain is by far the most difficult S to achieve. Sustain begins at the end. With each process, we must ask ourselves what do we wish to achieve, how will we measure our progress, and what tools and resources are available to help us measure this progress and sustain growth?

You can implement 5S strategy, but without a change agent or your monitoring, this will fall by the wayside and your business will have gone through a great exercise. Again this is a habit, then a behavior, and ultimately a business lifestyle we want to adopt for the rest of the life of our business.

When is the right time to go lean in your HME? I have been honored to introduce lean to countless HMEs over my career, and feel that the time has always been right. With the many changes taking place in our industry, I cannot think of a better time than now.

Ty Bello is president and founder of Team@Work LLC, Fort Wayne, Ind. He can be reached via e-mail: .