title: Lean Transformation of the Eye Clinic at The Hospital for Sick Children: Challenging an Implicit Mental Model and Lessons Learned.
abstract: Long patient dwell time (i.e., the time between patients arriving and leaving the clinic) has been a long-standing issue in the eye clinic at The Hospital for Sick Children. By applying the Lean principles of eliminating waste and enhancing flow, we achieved a 26% reduction in the mean patient dwell time over an eight-month period. Importantly, the average time a patient spent with healthcare providers (value-added time) increased from 21% to 31%. In this paper, we summarized our experience by illustrating how an implicit mental model (conscious or unconscious conceptual framework from which we understand the world) pervades in the healthcare system based on deeply held but unexamined assumptions that arise from heuristics (general rules of thumb) and biases; how these assumptions can be tested by objective data; and how we can build a new mental model based on objective findings to improve the healthcare system.
authors.affiliation: Ophthalmologist-in-chief and John & Melinda Thompson Chair in Vision Neurosciences at The Hospital for Sick Children, as well as professor of Ophthalmology and Vision Sciences at University of Toronto.
authors.forename: Agnes M F
authors.initials: AM
authors.lastname: Wong
authors.affiliation: Interim director of Process Improvement & Innovation at The Hospital for Sick Children.
authors.forename: David
authors.initials: D
authors.lastname: During
authors.affiliation: Director of Enterprise Project Management Office at The Hospital for Sick Children.
authors.forename: Michael
authors.initials: M
authors.lastname: Hartman
authors.affiliation: Senior clinical manager of Ophthalmology Clinic at The Hospital for Sick Children.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Lappan-Gracon
authors.affiliation: Director of Clinical Programs, Ambulatory, at The Hospital for Sick Children.
authors.forename: Melody
authors.initials: M
authors.lastname: Hicks
authors.affiliation: Director of process improvement, Innovation & Strategy Management, at The Hospital for Sick Children, and is currently on a leave of absence.
authors.forename: Shiraz
authors.initials: S
authors.lastname: Bajwa
mesh_terms: D000554:Ambulatory Care Facilities / Q000458:organization & administration*; D002648:Child; D017598:Efficiency, Organizational; D006776:Hospitals, Pediatric; D006801:Humans; D009864:Ontario; D009885:Ophthalmology / Q000458:organization & administration*; D058996:Quality Improvement; D013997:Time Factors; D057188:Workflow