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Moffitt physician, MBA alumnus, reduces waste for cancer center

Tim Kubal

Physician Tim Kubal helps cancer patients fight their disease at Moffitt Cancer Center.

But that's just his "day job" as a doctor. In his other role at Moffitt, the 2013 USF MBA alumnus works to help patients spend less time in the waiting room and more time getting the life-saving medical attention they need.

He is Moffitt's medical director of process excellence, and the oncologist says his career path was transformed after he took the Lean Six Sigma class in the Muma College of Business MBA program. The class teaches students to streamline processes, improve efficiencies and eliminate waste through "lean" processes that focus on what adds value to a customer and "Six Sigma" techniques that reduce error rates and variability.

"I got my job by combining my medical background with the MBA," said Kubal, who earned his medical degree from Florida State University in 2007.

Tim Kubal speaking to class

He speaks to USF students every semester in the same Lean Six Sigma class taught by Professor Ron Satterfield, telling them about how Lean management has transformed his career, Moffitt, and the patient experience.

"The reason Moffitt got involved in Lean is actually this class you're taking," he tells students. "I ended up getting the job, solely from having sat in this class. It can be the same for you."

Kubal said his experience with Lean and Six Sigma have helped him improve not only processes, but the way Moffitt engages with patients. Kubal said that originally, it took 84 steps for a new patient to get seen at Moffitt.

"Wouldn't you just want to be like, 'I have cancer and I want to see someone who can help me'?" Kubal asked.

That 84 steps represented one of the biggest forms of waste that Kubal and the Moffitt process improvement team examined: wasted time. The center spent more than $1 million annually on rescheduling appointments. Chemo treatment was on a first-come first-served basis, which led to a "Chemo Black Friday" phenomena, as Kubal called it, with a line out the door. Everyone would show up at the earliest possible time because they had cancer and wanted to be treated.

And, patients waited for doctors -- with an average of 60% of their time spent waiting rather than receiving care.

"When patients wait, they don't know why they're waiting," Kubal said. "Most of the time, they assume we're staring at a scan saying, 'This is the biggest tumor I've ever seen.' Waiting in healthcare -- and especially in oncology -- is not an acceptable thing."

Patients would spend hours in waiting rooms. Kubal shows the Six Sigma classes photos of bookcases filled with board games and puzzles. Families of cancer patients who died would come to Moffitt and donate their games for other patients to use. A Clue board game is on the bookshelf, which Kubal notes it takes an average of 90 minutes to play. The Lean team at Moffitt saw these games not as patients having fun in the waiting rooms, but as distractions that helped them forget about waiting.

The process improvement team at Moffitt has made changes that have resulted in wait times decreasing for patients in many areas of the hospital. They got rid of that "Black Friday" chemo system, now assigning patients specific appointment times.

"If you show up on time, you're seated on-time -- and the only place that can say that is Moffitt," Kubal said, noting that some of the best hospitals in the country follow first-come first-served models where patients still deal with two to three-hour wait times.

Kubal is proud of what Lean has enabled his organization to do, but said he keeps in mind the importance of humility when considering continuous improvement.

"Don't for a minute think that your organization has it correct," he said.