title: Using Lean Thinking at an otorhinolaryngology outpatient clinic to improve quality of care.
abstract: OBJECTIVE
  Although Lean Thinking has led to considerable improvement in a variety of healthcare settings, its effects on otorhinolaryngology remain underexposed. This study reports on how the implementation of Lean Thinking at an otorhinolaryngology outpatient clinic has affected patient and provider satisfaction, waste reduction, and organizational culture.
  
  
  METHODS
  Prospective before-and-after design.
  
  
  METHODS
  The 18-month prospective before-and-after design used mixed methods for data collection and analysis. A survey was conducted to measure satisfaction among patients and providers. Semistructured interviews were conducted to evaluate the effect of Lean Thinking on waste and organizational culture.
  
  
  RESULTS
  During the project, 69 issues were posted on the Lean board. Improvements were made on 36 inefficiency issues, not all concerning a specific type of waste. Employees reported considerable improvement in transportation, motion, and waiting. Patient satisfaction was high both at baseline and follow-up and did not change significantly. The effects on provider satisfaction were slight; satisfaction with autonomy and participation decreased significantly, but satisfaction with communication increased significantly.
  
  
  CONCLUSIONS
  The implementation of Lean Thinking at an otorhinolaryngology outpatient clinic reduced waste and increased provider satisfaction with communication. Although patient satisfaction did not change significantly, it cannot be concluded that the intervention had no effect on perceived quality of care. Other approaches to measure patients' perceptions should be considered.
  
  
  METHODS
  NA.
authors.affiliation: Department of Health Services Research , School for Public Health and Primary Care (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.
authors.forename: Janneke E
authors.initials: JE
authors.lastname: van Leijen-Zeelenberg
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Maastricht University Medical Center, Maastricht, the Netherlands.
authors.forename: Jan Wouter
authors.initials: JW
authors.lastname: Brunings
authors.affiliation: Department of Social Medicine , School for Public Health and Primary Care (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.
authors.forename: Inge
authors.initials: I
authors.lastname: Houkes
authors.affiliation: Department of Health Services Research , School for Public Health and Primary Care (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.
authors.forename: Arno J A
authors.initials: AJ
authors.lastname: van Raak
authors.affiliation: Department of Health Services Research , School for Public Health and Primary Care (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.
authors.forename: Dirk
authors.initials: D
authors.lastname: Ruwaard
authors.affiliation: Department of Patient and Care, Maastricht University Medical Center, Maastricht, the Netherlands.|Saw Swee Hock School of Public Health, National University of Singapore, Singapore.|Scientific Center of Care and Welfare (Tranzo), Tilburg University, Tilburg, the Netherlands.
authors.forename: Hubertus J M
authors.initials: HJ
authors.lastname: Vrijhoef
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Maastricht University Medical Center, Maastricht, the Netherlands.
authors.forename: Bernd
authors.initials: B
authors.lastname: Kremer
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities; D003695:Delivery of Health Care / Q000592:standards*; D005260:Female; D006801:Humans; D007588:Job Satisfaction; D008297:Male; D008875:Middle Aged; D010036:Otolaryngology / Q000592:standards*; D017060:Patient Satisfaction; D011446:Prospective Studies; D058996:Quality Improvement; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Lean Thinking; Quality improvement; mixed methods; otolaryngology; outpatient clinic