Use of Lean Six Sigma to Improve Access to Care in a Surgical Subspecialty Clinic

Published on Feb 5, 2020in Military Medicine0.853
· DOI :10.1093/milmed/usz426
James T Flanary (UMN: University of Minnesota), Nicholas R. Rocco1
Estimated H-index: 1
(NMCSD: Naval Medical Center San Diego)
+ 1 AuthorsMatthew S. Christman11
Estimated H-index: 11
(NMCSD: Naval Medical Center San Diego)
  • References (15)
  • Citations (0)
#1Dominique R. Ansell (U of O: University of Ottawa)H-Index: 5
#2James A. G. Crispo (UPenn: University of Pennsylvania)H-Index: 6
Last. Lise M. BjerreH-Index: 12
view all 4 authors...
Accessibility and availability are important characteristics of efficient and effective primary healthcare systems. Currently, timely access to a family physician is a concern in Canada. Adverse outcomes are associated with longer wait times for primary care appointments and often leave individuals to rely on urgent care. When wait times for appointments are too long patients may experience worse health outcomes and are often left to use emergency department resources. The primary objective of o...
12 CitationsSource
#1Nakul P. Valsangkar (IU: Indiana University)H-Index: 8
#2Andrew C. Eppstein (IU: Indiana University)H-Index: 4
Last. Amber N. TaylorH-Index: 1
view all 4 authors...
Importance There are an increasing number of veterans in the United States, and the current delay and wait times prevent Veterans Affairs institutions from fully meeting the needs of current and former service members. Concrete strategies to improve throughput at these facilities have been sparse. Objective To identify whether lean processes can be used to improve wait times for surgical procedures in Veterans Affairs hospitals. Design, Setting, and Participants Databases in the Veterans Integra...
7 CitationsSource
#1D Goodman (Dartmouth–Hitchcock Medical Center)H-Index: 1
#2G Ogrinc (Veterans Health Administration)H-Index: 1
Last. Johan Thor (Jönköping University)H-Index: 12
view all 21 authors...
Since its publication in 2008, SQUIRE (Standards for Quality Improvement Reporting Excellence) has contributed to the completeness and transparency of reporting of quality improvement work, providing guidance to authors and reviewers of reports on healthcare improvement work. In the interim, enormous growth has occurred in understanding factors that influence the success, and failure, of healthcare improvement efforts. Progress has been particularly strong in three areas: the understanding of th...
54 CitationsSource
#1Sam E. Mason (Imperial College London)H-Index: 8
#2C.R. Nicolay (Imperial College London)H-Index: 1
Last. DarziAra (Imperial College London)H-Index: 100
view all 3 authors...
Background: Lean and Six Sigma are improvement methodologies developed in the manufacturing industry and have been applied to healthcare settings since the 1990s. They use a systematic and reproducible approach to provide Quality Improvement (QI), with a flexible process that can be applied to a range of outcomes across different patient groups. This review assesses the literature with regard to the use and utility of Lean and Six Sigma methodologies in surgery.
86 CitationsSource
#1E.V. Gijo (ISI: Indian Statistical Institute)H-Index: 15
#2Jiju Antony (University of Strathclyde)H-Index: 51
This article addresses the issue of longer patient waiting time in the outpatient department (OPD) of a super specialty hospital attached to a manufacturing company in India. Due to longer waiting times at OPD, employees need to be away from the workplace for a longer duration. This problem was addressed through the Lean Six Sigma (LSS) methodology. The process, starting from registration of a patient to dispensing of medicine, was included in the project. The non-value added steps in the proces...
51 CitationsSource
#1Sean C. Skeldon (U of T: University of Toronto)H-Index: 6
#2Andrea Simmons (UHN: University Health Network)H-Index: 1
Last. Neil E. Fleshner (U of T: University of Toronto)H-Index: 57
view all 7 authors...
Objective To determine if lean methodology, an industrial engineering tool developed to optimize manufacturing efficiency, can successfully be applied to improve efficiencies and quality of care in a hospital-based high-volume uro-oncology clinic. Methods Before the lean initiative, baseline data were collected on patient volumes, wait times, cycle times (patient arrival to discharge), nursing assessment time, patient teaching, and physician ergonomics (via spaghetti diagram). Value stream analy...
20 CitationsSource
#1Joseph R. SteeleH-Index: 10
#2Ryan K. Clarke (University of Texas MD Anderson Cancer Center)H-Index: 4
Last. Tonya R. Brightmon (University of Texas MD Anderson Cancer Center)H-Index: 1
view all 4 authors...
A continuous quality improvement project at an interventional US clinic decreased scheduling delays for US examinations and biopsies from 25 days to 1 day by restructuring staff schedules to match patient demand, moving nonprocedural activities from the procedure room, and creating a standard scheduling process for add-on appointments.
3 CitationsSource
#1Sandra Y. Lin (Johns Hopkins University)H-Index: 25
#2Dean Gavney (Johns Hopkins University)H-Index: 1
Last. Julie Cady‐Reh (Johns Hopkins University)H-Index: 1
view all 4 authors...
Objectives/Hypothesis To apply Lean Sigma, a quality-improvement strategy supported by tactical tools to eliminate waste and reduce variation, to improve efficiency of patient flow in a large tertiary otolaryngology clinic. The project goals were to decrease overall lead time from patient arrival to start of interaction with care provider, improve on-time starts of patient visits, and decrease excess staff/patient motion. Study Design Prospective observational study. Methods Patient flow was map...
22 CitationsSource
Purpose – The purpose of this paper is to conduct a comprehensive review and assessment of the extant Six Sigma healthcare literature, focusing on: application, process changes initiated and outcomes, including improvements in process metrics, cost and revenue. Design/methodology/approach – Data were obtained from an extensive literature search. Healthcare Six Sigma applications were categorized by functional area and department, key process metric, cost savings and revenue generation (if any) a...
32 CitationsSource
#1Rubina A. HeptullaH-Index: 19
#2Steven J. Choi (Boston Children's Hospital)H-Index: 1
Last. Peter F. Belamarich (Albert Einstein College of Medicine)H-Index: 9
view all 3 authors...
OBJECTIVE: To improve access to new pediatric endocrinology appointments in an urban academic hospital faculty-based practice. METHODS: Three strategies were implemented to increase the number of appointment slots: new patient appointments were protected from conversion to follow-up appointments; all physicians, including senior faculty, were scheduled to see 3 to 4 new patients per session; and sessions devoted exclusively to follow-up appointments were added based on demand. The main outcomes ...
6 CitationsSource
Cited By0