LEAN Implementation Reduces Wait Times and Improves Patient Satisfaction in Clinics

Waiting is one part of a clinic visit that patients at Avera Gutnik & Associates are doing a lot less of, after a LEAN team initiated a number of efficiencies, all planned with the goal of bringing about greater patient satisfaction.

"We made a significant number of changes, both big and small, in how the clinic operates to help improve the patient experience," said Scott Jansen, Avera McKennan clinic project manager for network operations.

Patients Self Room with a Patient Services Representative

The change probably most noticed by patients is that they now self-room. When they check in at the reception desk, instead of sitting in the waiting room until the nurse calls their name, a Patient Service Representative (PSR) directs patients to an exam room. This saves nurses walk time and speeds up the process of seeing patients. To help patients, the team devised a number of visual cues. Scales were placed in all exam rooms, providing an additional degree of patient confidentiality and privacy.

While they may have wondered at such a variance from traditional clinic procedure, most patients take the change in stride, Jansen said.
Nurse work stations were decentralized closer to exam rooms, and medical records were relocated to reduce the distance records are carried.

Streamlining the Patient's Routine During a Visit

Patients are also seeing a change in the typical routine of the nurse work-up. "One thing we saw in our video analysis is that patients were relaying their stories or symptoms to the nurse, and then telling that exact same information to the physician," Jansen said.
Both nurses and doctors were taking down this information in their notes.

Because this is key communication for the physician to hear, nurses are now taking and recording vital signs and getting a general confirmation of the reason for the visit, and assuring patients that it's more important for their physician to hear the details of their symptoms.

The LEAN team streamlined the clinic's supply replenishment system, so tools and supplies needed for exams and patient care are always at hand.

Scheduling templates were shifted, so one doctor's patients begin coming in at the top of the hour, and the second doctor's patients begin arriving five minutes later. This provides for no or little waiting at the receptionist desk, and improves patient confidentiality.

To date, the clinic has achieved about a 20 percent reduction in the amount of time the patient spends in the office, as staff work toward a goal of 35 percent. Doctors now have the potential to see four to seven additional patients each day, opening up more time slots for patients to see the physician of their choice.

Implementing the Successes Throughout the Clinic Network

While other clinics will go through the LEAN process, the LEAN team developed tools other clinic managers can immediately put to work, without going through a full implementation, such as work station organization and the 5-S system: sort, set in order, shine, standardize and sustain.

Goals include greater patient satisfaction, greater physician satisfaction, as well as employee satisfaction. "Patients are happy they get to see their doctor, without having to wait as long. Physicians are happy to be able to take care of more of their patients in a given day. And staff are happier that we've made their duties a little more efficient," Jansen said.