From Physical Therapist to a Career Change in Process Improvement

Dr. Michael Natarus, DPT, PCS, MBA is a Manager of Improvement Consulting at Lurie Children’s Hospital in Chicago, and a pediatric physical therapist. Below, he outlines his journey from clinician to process improvement specialist, spurred by his passion for improving the lives of children in the clinic and beyond.

My first dream job was being a summer camp counselor — and it started my path towards clinical care. I always gravitated towards helping campers who faced additional development/social challenges while away from home. I quickly realized being a camp counselor 3 months out of the yaer was not a sustainable long-term career. It did however, help me recognize I loved working with children and helping them navigate complex challenges and environments. Furthermore, science and anatomy were always my strengths and interests when it came to school.

When I first realized pediatric PT existed as a profession, I was awestruck. My dream job quickly became helping pediatric patients break free of the overwhelming hospital setting. After undergrad, PT school, and a pediatric residency, I accepted my dream job at Lurie Children’s Hospital of Chicago. I quickly completed competencies and found myself helping to navigate the challenges and complexities of early ICU mobility in the PICU and CCU setting. My job was incredible: I was helping kids heal and often break free of the hospital setting. We would mobilize kids on CRRT, VADs, and ventilators. I even, with the help of a huge team of cross disciplinary experts, mobilized our first post heart transplant kid to ride a bike while intubated. Incredible, unforgettable experiences.

While I at times have wished that was where my story ended, and I lived happily ever after as an inpatient PT, I cannot say that is the case. As much as I loved the patient care, I became frustrated with the inefficiencies that riddled my day. It got to the point where I would hyperfixate on everything I wasn’t able to do, because of the hospital system and operations. My frustrations were only amplified as we entered and navigated the COVID era. The hospital was not designed for this type of work, and I began to tinker with anything I could to make it more efficient. After four years of clinical care, an opportunity presented itself for me to move into a role as a process improvement consultant. It was the hardest choice I’ve ever made, and not one I took lightly. There was a lot of fear and anxiety about leaving my dream job in pursuit of the unknown. While there still remains a lot of unknown, I can say with certainty my passion and drive for my patients has never been stronger.

Here is my journey.

Let’s dive in.

Question 1 — What is “process improvement”?
Question 2 — What are some examples of “process improvement” in the clinic?
Question 3 — What is Lean Six Sigma?
Question 4 — What are some ways I can use Lean Six Sigma to improve processes at larger scales, such as within a hospital?
Question 5 — What are some resources I’ve found that have helped me along the way?
Question 6 — (I added because it always comes up) How did you transition out of clinical care?

Question 1 — What is “process improvement”?

Everything we as humans do is a process. In it’s most simplistic terms a process can be defined as the series of steps required for a service or good to be delivered. As an inpatient clinician, I became obsessed with the processes of my daily workflow. I started my day by getting my list of patients, chart reviewing, and then structuring my day in an efficient manner. My day then consisted of seeing patients (that’s a process), writing notes (that’s a process), and then completing additional aspects of care planning (processes!) Processes are everywhere, which means by nature, inefficiencies are everywhere. As a clinician I started to see these inefficiencies and challenge myself to correct them. 

We as clinicians are trained to find impairments, identify treatments to those impairments, test and retest, and then improve quality of life.

The parallels to the process improvement world are uncanny. Engineers, product managers, process improvement specialists, and multitudes of other professionals are trained to think and walk through a more formalized framework. We as clinicians walk the same path, though the jargon may be different. Process improvement at its core is: treating operational impairments to improve employee quality of life.

Question 2 — What are some examples of “process improvement” in the clinic?

A major inefficiency that I quickly recognized as a clinician was documentation.

We at the time, had one system for patient tracking, and another system for documentation (our EMR). I started out on one of my first major initiatives in seeing how I could eliminate the external system and bring both under the same umbrella of our EMR. Documentation notoriously is a necessary, but non-value added activity that clinicians are faced with completing. No one enters healthcare with a passion or love for writing notes! My most inefficient time of day, was note writing. This led to the realization that many other elements of our day to day documentation could be streamlined to offer relief to our clinicians.

After months of collaboration, our team rolled out a new, improved, and streamlined documentation structure. It was efficient and reduced unwanted variation that our old system was riddled with. Naturally, any process improvement initiative should be measurable. We were able to show time savings of roughly five minutes per note. While five minutes feels rather minute, extrapolated across our team of OT’s, this equaled roughly ½ FTE per month in documentation time saved. That’s another large group of patients who can receive care, thanks to a process being optimized.

Question 3 — What is Lean Six Sigma?

Lean Six Sigma is one of many frameworks utilized for process improvement. While I am formally trained in LSS, there are other options out there as well that can also accomplish similar outcomes. Lean Six Sigma is actually a combination of Lean and Six Sigma. Lean originates from the Japanese Toyota automobile industry and Six Sigma from the US based Motorola company. They complement one another nicely. Lean is primarily focused on eliminating waste from processes, while Six Sigma focuses on eliminating variation from a process. You can see how both work in tandem to accomplish the goal of creating a reliable and efficient process.

Question 4 — What are some ways I can use Lean Six Sigma to improve processes at larger scales, such as within a hospital?

As you can imagine, hospitals and really any sector within healthcare is riddled with waste and variability. Lean Six Sigma is a great framework to tackle many of these problems. However, you do not need to be formally trained to begin working on process improvement in your area.

Simply start looking at your daily workflow and perform small tests of change to improve your efficiencies. You’d be surprised how many people will go about their life, repeating the same mundane task day in and out without ever asking if there is a better way. Healthcare is the pinnacle of “we’ve always done it that way, so we continue to do it that way”. A word of caution though: Process improvement is similar to PT gait analysis skills — the moment you open your eyes to the reality that the world around us could be more efficient, similar to seeing gait abnormalities you simply cannot turn it off.

Question 5 — What are some resources I’ve found that have helped me along the way?

Initially when I was thinking about breaking from my clinical role, I felt a lot of guilt. I stumbled upon The Clinician Transition and Beyond These Clinic Walls. I went to a few of the the TCT meetups in Chicago which certainly helped me feel validated and confident in my decision. I call it my “Rehab for Recovering Rehab Professionals” group. Furthermore, I listen to many different podcasts, but my all time favorite is Rethinking by Adam Grant. I also read a lot. While pursing my DPT and MBA, reading was the last thing I wanted to do. Now I always have a book on my nightstand, and have returned to the joys of reading for growth and pleasure. I recently read Ikigai: The Japanese Secret to a Long and Happy Life and cannot recommend Man’s Search for Meaning enough.

Lastly, I am learning how to shamelessly network. I always respond to LinkedIn messages and emails, and have found that others in the PT community aim to pay it forward as well. It’s a continuous journey of finding where my passion, skills, and interests intersect with my goal of making the world a better place. I used to always ask my pediatric patients what they wanted to be when they grow up. Many would respond that ‘they don’t know’. My response was always the same, ‘me either’. Most thought I was joking, but I knew the truth behind the statement. I view my career and life like many other processes; there’s always room for growth and improvement. This nonclinical journey is not the one I imagined graduating with my DPT, but it’s certainly the journey I am happy to be on!

Question 6 — So, how did I transition out of clinical care?

Initially, I didn’t know that a PT could ever enter the realm of process improvement. I found a team embedded in my hospital that focused on process improvement work. This piqued my interest as an opportunity to expand my already budding interest in operational efficiency. I offered to be subject matter expert as a clinician on a few of their initiatives. This got my foot in the door with the team, and I began networking like crazy with them. I wanted to learn more. Once a job opened on their team, I presented on how I saw my skills aligning with the role. Flash forward three years and I am a manager within my team, helping to shape the direction and strategy of the department as a whole. While I certainly miss the day to day patient interactions and likely always will, I have found great pride in being able to enact projects and operational improvements that impact entire patient populations and clinical teams rather than those individual interactions. Additionally, surround yourself with the people who encourage you to stay true to your personal goals and purpose.

Clinician brains are wired to see a problem, communicate potential solutions, and then measure the improvement. You may already be a process improver, or efficiency seeker and not even realize it. Clinicians can make the world better one patient- or in my case, operational improvement at a time.

Lastly, clinical life is fulfilling, but incredibly difficult. It’s not quitting to leave the daily grind of that work behind in pursuit of larger and better dreams. I struggled with the feeling of abandoning my team, my patients, and my identity. I could not and would not have taken the blind leap into my nonclinical career without the support of my wife, colleagues (some rehab folks, others multidisciplinary), friends, and mentors. Surround yourself with people who see your potential and always are in your corner. Don’t accept your current situation as fact and continue to set goals for where you want to be. Around the time of me contemplating leaving the knowns of bedside care, I read Man’s Search for Meaning. The words of Viktor Frankl really resonated with my journey, and continue to shape my path forward: “When we are no longer able to change a situation, we are challenged to change ourselves”. And so that’s where my journey began — still as PT who creates meaningful change, just in a slightly different way.

So, go improve that process that’s been nagging you. You got this.