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

• Published in: Military medicine Vol. 185; no. 5-6; pp. e887 - e893
• Main Authors: Flanary, James T, Rocco, Nicholas R, Dougherty, Timothy, Christman, Matthew S
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 08-06-2020
• Subjects: Ambulatory Care Facilities; Appointments and Schedules; Efficiency, Organizational; Health Services Accessibility; Humans; Lean manufacturing; Patient satisfaction; Pediatrics; Six Sigma; Total Quality Management; Urology
• ISSN: 0026-4075; 1930-613X
• DOI: 10.1093/milmed/usz426

Abstract
Introduction
At the Naval Medical Center San Diego urology clinic, patients reported waiting for greater than 1 month for an initial consult. A Lean Six Sigma approach was used to improve access to care (ATC) and decrease variation in access by improving scheduling.
Methods
A Define-Measure-Analyze-Improve-Control approach was used. Delay to new patient visits was identified as the focus of intervention. The scheduling template was changed from a fixed stream to a modified wave based on simulation software analysis of appointment cycle times. Appointment length was adjusted based on cycle time analysis, and two rooms per clinician were used instead of one. The ratio of initial consults relative to established follow-ups and procedures was adjusted upward to better balance with the historic demand.
Results
Statistically significant improvement was seen in ATC and compliance with the Defense Health Agency (DHA) standard that new consults be seen within 28 days. Average days for a new consult to be seen were reduced by 7.2 days in the pediatric urology clinic (P < 0.0001) and 6.4 days in the adult urology clinic (P < 0.0001). Compliance with the Defense Health Agency 28-day ATC standard increased from a baseline of 69.2% to 88.9% and 61.7% to 84.4%, respectively, in the pediatric and adult clinics (P < 0.001 for both). Patient satisfaction was maintained at or above the goal threshold throughout the project.
Conclusions
An Lean Six Sigma model was used to improve timeliness of care for our patients, improving the overall quality of their healthcare experience. Simulation software can be used to model the clinic throughput and test alternative scheduling templates. ATC was significantly improved and patient satisfaction was maintained at or above goal thresholds.