title: Application of Lean Sigma to the Audiology Clinic at a Large Academic Center.
abstract: OBJECTIVE
  To apply Lean Sigma--a quality improvement strategy to eliminate waste and reduce variation and defects--to improve audiology scheduling and utilization in a large tertiary care referral center. The project goals included an increase in utilization rates of audiology block time and a reduction in appointment lead time.
  
  
  METHODS
  Prospective quality improvement study.
  
  
  METHODS
  Academic tertiary care center.
  
  
  METHODS
  All patients scheduling audiology clinic visits July 2013 to July 2014.
  
  
  METHODS
  Value stream mapping was performed for the audiology scheduling process, and wasteful steps were identified for elimination. Interventions included a 2-week block release, audiology template revision, and reduction of underutilized blocks. Schedule utilization and lead time for new patient diagnostic audiogram were measured for 5 months postintervention and compared with 5 months preintervention. Overall, 2995 preintervention and 3714 postintervention booked appointments were analyzed.
  
  
  RESULTS
  Block utilization increased from 77% to 90% after intervention (P < .0001). Utilization of joint-with-provider visits increased from 39% to 67% (P < .0001). Booked appointments increased from 2995 to 3714, with joint-with-provider booked appointments increasing from 317 to 1193. Appointment lead time averaged 24 days postintervention, compared with 29 days preintervention (P = .06). Average monthly relative value units measured 13,321 preintervention and 14,778 postintervention (P = .09).
  
  
  CONCLUSIONS
  Lean Sigma techniques were successfully used to increase appointment block utilization and streamline scheduling practices.
authors: Johns Hopkins Department of Otolaryngology-Head and Neck Surgery, Baltimore, Maryland, USA mhuddle2@jhmi.edu.
authors: Matthew G
authors: MG
authors: Huddle
authors: Johns Hopkins Department of Otolaryngology-Head and Neck Surgery, Baltimore, Maryland, USA.
authors: Amy
authors: A
authors: Tirabassi
authors: Johns Hopkins Department of Otolaryngology-Head and Neck Surgery, Baltimore, Maryland, USA.
authors: Laurie
authors: L
authors: Turner
authors: Johns Hopkins Department of Otolaryngology-Head and Neck Surgery, Baltimore, Maryland, USA.
authors: Emily
authors: E
authors: Lee
authors: Johns Hopkins Department of Otolaryngology-Head and Neck Surgery, Baltimore, Maryland, USA.
authors: Kathryn
authors: K
authors: Ries
authors: Johns Hopkins Department of Otolaryngology-Head and Neck Surgery, Baltimore, Maryland, USA.
authors: Sandra Y
authors: SY
authors: Lin
mesh_terms: D000046:Academic Medical Centers; D001071:Appointments and Schedules; D001298:Audiology / Q000592:standards*; D017598:Efficiency, Organizational; D006801:Humans; D010044:Outpatient Clinics, Hospital / Q000592:standards*; D011446:Prospective Studies; D058996:Quality Improvement
keywords: Lean; Six Sigma; clinic efficiency; clinic performance; outpatient clinic