Improving Patient Care Through Workspace Renovation and Redesign: A Lean Approach

Abstract

Background and Objectives: At a time when the US health care system needs greater access to comprehensive, on-demand primary care, the University of North Carolina Family Medicine Center found itself struggling to meet patient demands within the confines of an outdated facility. Clinic leadership sought to redesign the physical space to expand capacity, integrate other members of the care team, support extended hours of operation, and improve patient experience. Methods: Clinic leadership employed experienced lean coaches to train our entire department in lean methodology, to implement a comprehensive approach to redesigning our workflows, and to use those perfected workflows to redesign and renovate our new clinical workspace. Results: Upon completion of the renovation and redesign, the clinic experienced significant growth in patient volumes (24%) and unprecedented improvement in patient satisfaction (89th to 92nd percentile). Conclusions: Lean methodology proved to be an effective strategy for analyzing our current workflows and use of physical space. Moreover, lean strategies proved vital for redesigning and renovating our clinic.

Use of Lean Management to Increase Efficiency and Osteopathic Manipulative Treatment in a Family Medicine Residency

“…4,5 Other studies have shown that putting into play Lean management strategies has shown to reduce the patient wait times, time in a queue and increase satisfaction. [1][2][3][4][5][6] While the studies may be limited, other residency programs have also shown similar results and have led to increased involvement of residents in other quality initiatives. 8 The thought is that the success of Lean is attributed to the ability to identify the issues needing immediate assistance and provide suggestions for improvement in real time.…”

“…Due to its reported successes in many areas important to patient care, [1][2][3][4][5][6]8 Lean management was hypothesized to help achieve decreased wait times and increased utilization of OMT in patient visits. It was also thought that data from this study could assist other osteopathic recognized family medicine residency clinics in improving efficiency and enhancing time organization for better patient care.…”

“…Lean principles helped to significantly decrease patient wait times 5 or improved patient volumes and satisfaction through a better workflow in these residency settings. 6 Such time efficiency could be useful to a residency clinic where residents learn to optimize patient care and integrate osteopathic manipulative therapy (OMT) into visits.…”

Is It Worth the Wait? Patient Perceptions of Wait Time at a Primary Care Clinic

“…Strategies including self-rooming, physician block scheduling, and workspace redesign have demonstrated improved patient satisfaction. [16][17][18] As more clinics begin to offer Telemedicine appointments, particularly in response to the COV-ID-19 pandemic, wait time may have less of an impact on satisfaction than previously reported, since patients can continue their normal routine at home or work while waiting. Future research could adapt this survey for virtual patients and reexamine the perceptions of punctuality and quality during virtual appointments.…”

Breaking Down Silos by Sharing Innovation in Academic Family Medicine

“…12 Similarly, Tommy Koonce, MD, MPH and Dana Neutze, MD, PhD, discuss in detail the redesign of an academic family medicine practice, demonstrating that it can be done without compromising patient care during renovation, and the ultimate result is increased access while bolstering quality of care. 13 A third paper addresses both value and economic impact by presenting the effect of a minor procedure service on the cost of care for a health plan, modeling the potential GUEST EDITORIAL for considerably decreased cost of care by providing minor procedures in the primary care setting. 14 Rather than referring patients to costlier specialists, family physicians utilize their full-scope training to perform skin, musculoskeletal, and reproductive procedures, yielding a 70% cost savings for patients and a $2.33 return on every dollar spent to implement and maintain the service, not to mention the increase in convenience for patients.…”