title: The Lean method as a clinical pathway facilitator in patients with lung cancer.
abstract: BACKGROUND
  Patient flow during workup for lung cancer is often difficult to influence because of delay at many levels: patient delay, doctors' delay and waiting time for X-ray and CT scan, referral to specialist, and waiting time for chemotherapy and radiotherapy or surgery. A mean workup time of 4 months is not unusual.
  
  
  OBJECTIVE
  To improve quality and shorten the workup time for patients with lung cancer.
  
  
  METHODS
  It was decided to employ a program designed by the Toyota car industry, the Lean process, as a tool to improve workup time. A Lean process implicates all levels of an institution with project and focus groups having workshops to analyse present status and suggest improvements.
  
  
  RESULTS
  Since introducing the Lean project, we have decreased the workup time from a mean of 64 days to 16 days, and the median time from diagnosis to surgery was reduced from 26.5 days to 15 days.
  
  
  CONCLUSIONS
  It is feasible to improve patient flow for patients with lung cancer by employing the Lean method as a pathway instrument.
authors.affiliation: Heart and Lung Clinic, University Hospital of North Norway, Tromsø, Norway. ulf.aasebo@unn.no
authors.forename: Ulf
authors.initials: U
authors.lastname: Aasebø
authors.forename: Hans Henrik
authors.initials: HH
authors.lastname: Strøm
authors.forename: Merete
authors.initials: M
authors.lastname: Postmyr
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis* / Q000601:surgery*; D000077192:Adenocarcinoma of Lung; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis / Q000601:surgery; D019091:Critical Pathways / Q000458:organization & administration* / Q000592:standards; D005240:Feasibility Studies; D005500:Follow-Up Studies; D006785:Hospitals, University / Q000458:organization & administration / Q000592:standards; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000601:surgery*; D017146:Models, Organizational; D017063:Outcome Assessment, Health Care; D011785:Quality Assurance, Health Care / Q000379:methods / Q000458:organization & administration; D013997:Time Factors