Improving the Workflow Efficiency of an Outpatient Pain Clinic at a Specialized Oncology Center by Implementing Lean Principles

Abstract

Objective: Adult outpatient oncology pain clinics face many challenges due to the increased number of patients, the restriction of electronic appointment systems, overcrowding, waiting time, and patient dissatisfaction. This project aimed to improve clinic time efficiency, decrease clinic waiting time, and improve patient satisfaction. Methods: Lean thinking concepts and their tools, for example, value-stream mapping and value added (VA)/non-VA (NVA) analysis were used. Electronic appointment system slots were stratified based on patient visit type. A total of 187 patients were included in a time-motion survey at three different occasions: preintervention ( n = 67) and two consecutive quarter postintervention time points ( n = 64, n = 56). Simultaneously, patient satisfaction was reported quarterly by a quality management office. Results: The pain clinic workflow became more efficient; the mean clinic waiting time decreased from 72.5 min at preintervention to 19.5 and 21 min at the two postintervention quarters, respectively. Moreover, patient satisfaction improved from 75% at the preintervention to 100% and 96.7% at the two postintervention quarters. Conclusions: Redesigning the process of an electronic appointment system using lean thinking considerably decreases patients’ waiting time, improves patient satisfaction, improves resource utilization, allows proper scheduling based on patient visit types, eliminates unnecessary waste processes, and reallocates health-care providers’ time toward direct, individualized patient care.

Discrete Event Simulation for Clinic Design

“…Resource allocation to determine staffing levels or physical environment resources for optimal use of the facility is the most prevalent application of DES (Mielczarek & Uziałko-Mydlikowska, 2012;Vahdat et al, 2018). Previous studies have employed DES to examine the advantages of pooling resources when designing outpatient facilities (al Hroub et al, 2019;Ciulla et al, 2018;Norouzzadeh et al, 2015;Vahdat et al, 2018;Vanberkel et al, 2012). For example, Rohleder et al (2007) employed simulation modeling to show how consolidating smaller facilities into broader patient service center networks provides opportunities for pooling resources (such as exam rooms), reduces demand variability, improves resource utilization, and decreases patient waiting time.…”

“…In addition to employing telehealth as a promising tool to improve access to care, the increased outpatient volume has increased pressure to enhance operations, costs, and resource utilization through different strategies, including resource pooling (Hong et al, 2013;Vahdat et al, 2019). Pooling is one of the most prevalent strategies in outpatient clinics to streamline processes, reduce waiting time, and improve patient and staff satisfaction through resources (al Hroub et al, 2019;Ciulla et al, 2018;Norouzzadeh et al, 2015;Vahdat et al, 2018;Vanberkel et al, 2012).…”

“…The planning, design, and construction of multi-department outpatient healthcare facilities are complicated, expensive, and complicated (al Hroub et al, 2019;Suhaimi et al, 2018;Vahdat et al, 2019). These facilities include multiple stakeholder processes, including physicians, nurses, nurse assistants, and patients (Hong et al, 2013;Suhaimi et al, 2018;Vahdat et al, 2019;Vázquez-Serrano et al, 2021).…”

“…Given the complexity of mulita-department outpatient healthcare facility operations, Discrete Event simulation (DES) is considered an effective tool for evaluating resource pooling, performance outcomes, resource utilization, capacity planning, and turnaround times across different situations (al Hroub et al, 2019;Hong et al, 2013;Vahdat et al, 2018Vahdat et al, , 2019Vanberkel et al, 2012;Vázquez-Serrano et al, 2021). Through the DES evaluation, the design strategies for multi-department clinic design are integrated with critical components of operations to achieve higher-quality patient-centered care outcomes (Cai & Jia, 2019;Vahdat et al, 2018).…”

The Role of Value Stream Mapping in Healthcare Services: A Scoping Review

“…The satisfaction problem for [79,84,89,99,108,129,150] or workers in health centers [86,107] comes across in nine articles. Nonetheless, it must be pointed out that in those cases when the lead time or waiting time has probably improved, it may be associated with patient satisfaction.…”