title: Lean methodology improves efficiency in outpatient academic Gynecologic Oncology clinics.
abstract: OBJECTIVE
  Patient satisfaction scores may be used as a measure of quality of care, but outpatient scores are significantly and negatively affected by long clinic wait times. Patients in academic Gynecologic Oncology clinic at UVA for chemotherapy visits experience multiple wait times during a complex multipurpose visit. The purpose of this study was to utilize Lean methodology to identify variability in patient flow in order to guide solutions for improvement.
  
  
  METHODS
  A value stream map of our clinic process was created. Patient surveys and clinical timestamps were used to identify which visit components were contributing to delays and to identify process variability. After results were analyzed, a process change was instituted, with the patient surveys then repeated.
  
  
  RESULTS
  In the first phase, women experienced short wait times for the first appointment, but the average wait time between appointments gradually increased, with a peak mean wait time of 65 min (range 38-108) just prior to drug infusion. The total mean wait time (including all visits) was 119 min (range 81-154). After instituting process intervention, the overall wait time decreased significantly (82 vs 119 min, p=0.001), but was still affected by aspects of the process that were outside of the investigators' control.
  
  
  CONCLUSIONS
  Analyzing patient flow through an academic Gynecologic Oncology clinic can elucidate inefficiencies and guide improvements. Change in process can meaningfully affect overall waiting time. Next steps include instituting a more global change in process, as well as linking results to patient satisfaction scores.
authors.affiliation: Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Virginia, Charlottesville, VA 22908, United States. Electronic address: lduska@virginia.edu.
authors.forename: Linda R
authors.initials: LR
authors.lastname: Duska
authors.affiliation: Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Virginia, Charlottesville, VA 22908, United States.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Mueller
authors.affiliation: Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Virginia, Charlottesville, VA 22908, United States.
authors.forename: Heather
authors.initials: H
authors.lastname: Lothamer
authors.affiliation: Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Virginia, Charlottesville, VA 22908, United States.
authors.forename: Elizabeth B
authors.initials: EB
authors.lastname: Pelkofski
authors.affiliation: Department of Public Health Sciences and Orthopaedic Surgery, University of Virginia, Charlottesville, VA 22908, United States.
authors.forename: Wendy M
authors.initials: WM
authors.lastname: Novicoff
mesh_terms: D000554:Ambulatory Care Facilities / Q000592:standards*; D005260:Female; D005833:Genital Neoplasms, Female / Q000188:drug therapy*; D006801:Humans; D008495:Medical Oncology / Q000379:methods* / Q000592:standards*; D017060:Patient Satisfaction; D011787:Quality of Health Care; D014850:Waiting Lists
keywords: Gynecologic Oncology; Lean; Outpatient