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The purpose of this paper is to apply Lean in the workers’ compensation industry. It focuses on identifying patterns of repetitive non-value-added transnational activities for physical-therapy patients and healthcare providers. It addresses the research gap in this field.

In this study, we designed and deployed multiple case studies to better understand the journey of an injured worker within the worker compensation system in the United States of America. We partnered with Concentra Inc., a leading national healthcare provider in the field of workers’ compensation having 520 medical centers in 44 states. Both case studies included conducting direct observations, Gemba walk, in five clinics in two states: Florida and Pennsylvania. We analyzed the data of 263 injured workers with 8 or more physical therapy visits who got admitted to Concentra clinics in both states over the period of 31 days.

The results revealed that the time intervals at which activities associated with physical therapy treatment pre-authorization accounted for 91.59% of the total non-value-added activities and are thus the key administrative factor leading to process inefficiency in the state of Florida. The Process Cycle Efficiency of Pennsylvania was 75.36% compared to 53.16% of Florida. The injured workers in Florida needed 39.58 days on average to complete eight physical therapy visits compared to 27.92 days in Pennsylvania (a median of 34.09 vs 22.15 days).

This study is limited as it only focuses on processes on the healthcare provider side. An expanded value stream map that includes the treatment pre-authorization process on the insurance side would be beneficial for generating more potential solutions to streamline the process.

This study shows that Lean could play a critical role in identifying and quantifying continuous improvement opportunities that could accelerate patient’s treatment, reduce administrative burden on healthcare providers and improve the overall claim cost of insurance companies. It provides data-driven argument for insurance companies to consider eliminating physical therapy pre-authorization.

This is the first study to apply Lean methodology in the workers’ compensation field.

In recent years, Screening and Brief Intervention (SBI) has become increasingly available to older adults who engage in at-risk drinking behaviors. The results of SBI training sessions that targeted hospital-based healthcare providers, as well as mental health service providers in community-based clinics, are reported. The paper aims to discuss these issues.

In total, 93 participants attended SBI active learning training sessions. The responses of physicians/physicians in training about their intentions to apply the information in professional practice and their willingness to recommend the training to others in their profession were compared to practitioners in other professions.

Although there were no differences in terms of commitment to apply the information or level of comfort using the techniques, physicians/physicians in training were less interested in promoting the SBI training among their colleagues.

The results are limited with respect to the number of training participants engaged and the geography entailed, yet implications for addressing barriers to widespread implementation and training challenges are explored.

Although it may be more difficult to promote SBI training in locations that do not primarily provide mental health services, hospitals, and other primary care settings are precisely where training may be most useful.

The importance of training approaches to SBI that are disseminated within the context of a public health model of clinical preventive services is highlighted.

Original research is presented to highlight the need to improve training receptivity and facilitate the translation into practice.