title: Use of lean sigma principles in a tertiary care otolaryngology clinic to improve efficiency.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  Patient flow was mapped through the clinic, including preregistration processes. A time-stamp observation study was performed on 188 patient visits over 5 days. Using Lean Sigma principles, time stamps were analyzed to identify patient flow constraints and areas for potential interventions. Interventions were evaluated and adjusted based on feedback from shareholders: removal of bottlenecks in clinic flow, elimination of non-value added registration staff tasks, and alignment of staff hours to accommodate times of high patient census. A postintervention time observation study of 141 patients was performed 5 months later.
  
  
  RESULTS
  Patient lead time from clinic arrival to exam start time decreased by 12.2% on average (P = .042). On-time starts for patient exams improved by 34% (χ(2) = 16.091, P < .001). Excess patient motion was reduced by 74 feet per patient, which represents a 34% reduction in motion per visit.
  
  
  CONCLUSIONS
  Use of Lean Sigma principles in a large tertiary otolaryngology clinic led to decreased patient wait time and significant improvements in on-time patient exam start time. Process mapping, engagement of leadership and staff, and elimination of non-value added steps or processes were key to improvement.
authors.affiliation: Johns Hopkins School of Medicine, Department of Otolaryngology Head and Neck Surgery.
authors.forename: Sandra Y
authors.initials: SY
authors.lastname: Lin
authors.forename: Dean
authors.initials: D
authors.lastname: Gavney
authors.forename: Stacey L
authors.initials: SL
authors.lastname: Ishman
authors.forename: Julie
authors.initials: J
authors.lastname: Cady-Reh
mesh_terms: D000554:Ambulatory Care Facilities / Q000592:standards; D004526:Efficiency; D006801:Humans; D010036:Otolaryngology / Q000592:standards; D010038:Otorhinolaryngologic Diseases / Q000628:therapy*; D011446:Prospective Studies; D058996:Quality Improvement; D062606:Tertiary Care Centers / Q000592:standards; D063128:Tertiary Health Care / Q000592:standards; D057188:Workflow
keywords: Lean; Six Sigma; ambulatory flow; clinic efficiency; clinic performance; outpatient clinic; patient flow