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Volume 45, Issue 7, Pages 1420-1425 (July 2010)


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Application of lean methods improves surgical clinic experience

John H.T. WaldhausenCorresponding Author Informationemail address, Jeffrey R. Avansino, Arlene Libby, Robert S. Sawin

Received 22 July 2009; received in revised form 13 October 2009; accepted 14 October 2009.

Abstract 

Background

A quality visit in high volume surgery clinics is challenging. There is variability in numbers of patients seen and care provider behavior. Documentation, regulatory and compliance issues and computerization of patient care systems may decrease clinic efficiency and throughput. We tried to reduce variability and improve patient experience.

Methods

Baseline data included: patients seen, time in exam rooms, and spent with providers, and patient satisfaction surveys. Two Rapid Process Improvement Workshops (RPIWs) were conducted to apply lean methods. 5S techniques helped standardize exam rooms. Similar data were collected at 30 days, 60 days, and 1 year. Satisfaction surveys were followed at 6 months and 1 year.

Results

Median pre-RPIW room time was 49 minutes. Post-RPIW times were 33 minutes at 30 days, 41 minutes at 60 days, and 42 minutes at 1 year. Face to face provider-patient time increased 30% to 61% at 30 days, 58% at 60 days, and 59% at 1 year. The median number of patients in a 4-hour clinic increased from 10 to 12. Satisfaction survey Problem Scores improved and were sustained.

Conclusions

Lean methodology may be used to improve clinic efficiency as well as patient and staff's experience.

Division of Pediatric Surgery, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA 98105, USA

Corresponding Author InformationCorresponding author. Department of Surgery, Seattle Children's Hospital, NE, Seattle, WA 98105, USA. Tel.: +1 206 987 1177; fax: +1 206 987 3925.

PII: S0022-3468(09)00847-1

doi:10.1016/j.jpedsurg.2009.10.049


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