Using Lean Six Sigma techniques to improve efficiency in outpatient ophthalmology clinics

Abstract

Background Increasing patient numbers, complexity of patient management, and healthcare resource limitations have resulted in prolonged patient wait times, decreased quality of service, and decreased patient satisfaction in many outpatient services worldwide. This study investigated the impact of Lean Six Sigma, a service improvement methodology originally from manufacturing, in reducing patient wait times and increasing service capacity in a publicly-funded, tertiary referral outpatient ophthalmology clinic. Methods This quality improvement study compared results from two five-months audits of operational data pre- and post-implementation of Lean Six Sigma. A baseline audit was conducted to determine duration and variability of patient in-clinic time and number of patients seen per clinic session. Staff interviews and a time-in-motion study were conducted to identify issues reducing clinic service efficiency. Solutions were developed to address these root causes including: clinic schedule amendments, creation of dedicated postoperative clinics, and clear documentation templates. A post-implementation audit was conducted, and the results compared with baseline audit data. Significant differences in patient in-clinic time pre- and post-solution implementation were assessed using Mann-Whitney test. Differences in variability of patient in-clinic times were assessed using Brown-Forsythe test. Differences in numbers of patients seen per clinic session were assessed using Student’s t-test. Results During the baseline audit period, 19.4 patients were seen per 240-minute clinic session. Median patient in-clinic time was 131 minutes with an interquartile range of 133 minutes (84–217 minutes, quartile 1- quartile 3). Targeted low/negligible cost solutions were implemented to reduce in-clinic times. During the post-implementation audit period, the number of patients seen per session increased 9% to 21.1 (p = 0.016). There was significant reduction in duration (p < 0.001) and variability (p < 0.001) of patient in-clinic time (median 107 minutes, interquartile range 91 minutes [71–162 minutes]). Conclusions Lean Six Sigma techniques may be used to reduce duration and variability of patient in-clinic time and increase service capacity in outpatient ophthalmology clinics without additional resource input.

Lean six sigma in the healthcare sector: A systematic literature review

“…(2020) Descriptive India [ 93 ] 31 The critical failure factors for introducing a long-term lean six sigma system in an organisation were assessed. (2020) Descriptive India [ 94 ] 32 In outpatient ophthalmology clinics, Lean Six Sigma methods have been used to increase the performance. (2021) Empirical India [ 95 ] 33 A case report of a Thai hospital which used Lean Six Sigma to reduce medication errors.…”

Six Sigma in blood transfusion services: A dream too big in a third world country?

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Promoting the practice of exclusive breastfeeding: a philosophic scoping review

“…Though the included studies in this review did not use Lean Six Sigma model, the model is a process improvement model involving five phases: define, measure, improve, analyse, and control. Lean Six Sigma model, which has been successfully used to develop interventions that reduced patient waiting time at clinics [ 74 ], may be applied to design system interventions to promote EBF.…”