Introduction . In Uruguay, the special care required for children with neurodevelopmental disorders presents difficulties including lack of access to specialists and rehabilitation services. Project ECHO (Extension for Community Healthcare Outcomes) connects primary care clinicians from remote areas to specialists to enable them to treat complex conditions through ongoing education and mentoring. Objective . To share the experience of the ECHO Autism program during the first 2 years of implementation. Methods . Analysis of ECHO Autism clinics from June 2015 to June 2017 including clinical cases presented participants’ self-perception of changes in skills and competences. Results . Twenty clinical cases were presented: mean age 4.5 years; 15 were males; and 17 with medical and psychiatric comorbidities. After ECHO Autism implementation, a statistically significant improvement in participants’ self-perception of skills and competences was observed. Conclusions . ECHO Autism in Uruguay is a meaningful approach to autism care and offers improved access to best practice care.

Purpose This paper aims to outline the barriers in introducing Lean in health care and to asses which of these have a greater impact in the Uruguayan health-care sector. Design/methodology/approach To uncover the barriers hindering Lean health-care implementation, a literature review was undertaken. Once identified, first-hand information was obtained from managers and professionals involved in managerial activities who evaluated each of the difficulties using a Likert scale. Findings In total, 17 barriers to the implementation of Lean health care were identified. Survey results show that the highest scores correspond to “controllable” barriers, those which can be overcome, almost exclusively, by the organization willing to implement the program. Practical implications Managers need to understand and ascertain the existing barriers before implementing Lean if they want to develop strategies to mitigate them. Although the exploratory study was conducted in the Uruguayan health-care sector, it could be replicated elsewhere. Originality/value An exhaustive list of barriers was synthesized and was later assessed by managers in the Uruguayan context. This is an important first step that could help foresee obstacles and develop strategies prior future implementation.