Use of Lean Methodologies in Outpatient Urology Clinic

Introduction: Our objective was to apply lean methodologies to identify and improve processes in the urology clinic. Methods: A total of 85 appointments in provider and procedure clinics were observed and analyzed using time studies, spaghetti diagrams and process mapping tools. The team determined wait times and rework as areas for quality improvement. Rework is defined as the technician or provider having to see the patient multiple, separate times during a visit. We implemented assigning 1 technician to 1 provider, prepping patient charts in advance, and daily huddles. The team performed a PDSA (Plan, Do, Study, Act) cycle and observed 53 more appointments. Results: Through these interventions the clinic saw improvements in all areas of concern. In the provider clinic, the initial wait times decreased by 63%. Rework decreased by 48%. The overall number of technician rework decreased by 17% and overall provider rework decreased by 50% saving a median of 6 minutes per visit. The procedure clinic saw improvements including up to a 43% decrease in the initial wait time, the chance of all rework decreasing by 55% and the technician rework decreased by 36%, saving 16 minutes per visit. Conclusions: These interventions proved beneficial in reducing waste and operating a more effective and efficient clinic.