Use of Lean Six Sigma to Improve Access to Care in a Surgical Subspecialty Clinic

Flanary, James; Rocco, Nicholas R; Dougherty, Timothy; Christman, Matthew

doi:10.1093/milmed/usz426

Cited by 9 publications

(17 citation statements)

References 14 publications

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“…To the best of our knowledge, the present study is the first to investigate the effects of Six Sigma methodology on the incidence of depression and anxiety in ESRD patients. Previous studies have confirmed that Six Sigma methodology could improve the timeliness of care and the overall quality of nursing care in several departments (21,22). We then modified conventional Six Sigma methodology and added some cognitive-behavioral therapy into it to focus on the improvement of psychological conditions in ESRD patients.…”

Section: Discussionmentioning

confidence: 99%

Effects of Six Sigma methodology on depression and anxiety of patients with end-stage renal disease

Yang¹,

Wang²,

Cao³

et al. 2021

Ann Palliat Med

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Background: Depression and anxiety are common psychological conditions in end-stage renal disease (ESRD) patients and contribute to poor quality of life and increased mortality. Six Sigma methodology is a novel method of hospital management. The aim of the present study was to determine whether Six Sigma methodology could reduce the incidence of depression and anxiety in ESRD patients. Methods: ESRD patients undergoing hemodialysis from March 2018 to February 2020 were enrolled in the study. They were divided into the control group or study group according to whether they received conventional nursing care or Six Sigma methodology, respectively. Data on patients' demographic characteristics were retrospectively collected. The conditions of depression and anxiety were assessed by the Self-Rating Depression Scale and the Self-Rating Anxiety Scale, and the severity of depression and anxiety was defined according to the scores of the scales. Univariable and multivariable logistic regression analyses were used to determine the risk factors of depression and anxiety at discharge in ESRD patients and the effects of Six Sigma methodology on them. Results: A total of 251 patients were retrospectively enrolled in the study, with 112 patients in the control group and 139 patients in the study group. There were no significant differences in the collected demographic characteristics between the two groups. Six Sigma methodology was shown to relieve mild and moderate depression and anxiety at discharge; however, severe depression and anxiety was hardly affected by Six Sigma methodology. The results from multivariable logistic regression analysis identified Six Sigma methodology as an important protective factor of psychological conditions at discharge. Depression and anxiety status at admission and older age are also independent risk factors for anxiety at discharge in ESRD patients. Marital status may also play a role in the incidence of depression. Conclusions: Six Sigma methodology is significantly useful to reduce the incidence of mild and moderate depression and anxiety at discharge, and should be extended to improve psychological conditions in ESRD patients.

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Section: Discussionmentioning

confidence: 99%

Effects of Six Sigma methodology on depression and anxiety of patients with end-stage renal disease

Yang¹,

Wang²,

Cao³

et al. 2021

Ann Palliat Med

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“…Balancing patient quality of care and efficiency is an ongoing issue in healthcare, with clinic workflows hampered or negatively impacted for a variety of reasons. This may include poor or inadequate space or work layouts, and/or excessive workload resulting from inefficiencies in work processes, factors which can increase patient wait times and may lead to provider burnout (Flanary et al, 2020). Quality Improvement (QI) studies are focused on improving these types of conditions and can take many forms.…”

Section: Issues With Clinical Workflow Healthcare Environments and Wait Timesmentioning

confidence: 99%

“…Quality Improvement (QI) studies are focused on improving these types of conditions and can take many forms. Some QI methods that have been used to increase efficiency and reduce wait times include eliminating automatic rebooking or overbooking, adjusting the ratio of new patient visits to follow-up visits, and increasing the use of physician assistants (Flanary et al, 2020). This QI study aimed to reveal potential bottlenecks that may be impacting the overall workflow of the Genetics Clinic, with a particular focus on the work of GCs in patient workflows.…”

Section: Issues With Clinical Workflow Healthcare Environments and Wait Timesmentioning

confidence: 99%

“…One possible tool that has been used to improve clinical workflow is called Lean Improvement. 'Lean' was pioneered by Toyota in the 1970s, with a focus on stable, standard processes to provide the best quality and efficiency by eliminating waste/unnecessary steps (Flanary et al, 2020;Lin et al, 2013). Lean Improvement projects use the Define-Measure-Analyze-Improve-Control (DMAIC) methodology (Gijo & Antony, 2014).…”

Section: Lean Improvement Approach To Improve Clinical Workflowmentioning

confidence: 99%

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Improving Genetics Clinic Efficiency and Capacity Using Design and Human Factors Methods

Attef

Cloutier

Gillespie

et al. 2021

Proceedings of the International Symposium on Human Factors and

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This quality improvement study focused on developing an understanding of factors influencing the ability of prenatal genetics counsellors (GCs) to efficiently see patients during the COVID-19 pandemic and strategies to improve their workflow using techniques from human factors and design. The demand for Prenatal Genetics Clinics is rising which has increased pressure on GCs to become more efficient. Genetics counsellors can improve access to their services by reducing the time spent on the tasks performed before and after a genetic counselling encounter, thereby increasing the number of patients they see. We were limited to certain methods to understand the differences in workflow before and during the COVID-19 pandemic. This study involved a literature review, archival analysis of workflow studies conducted before the pandemic, stakeholder meetings and mapping, a brainstorming session, as well as documenting time-on-task in a diary and naturalistic observation sessions. A task analysis was developed to identify factors influencing efficiency related to the design of the space, processes and the use of artefacts. Virtual and on-site workflows show that GCs spend at least half of their time on tasks before and/or after the patient’s appointment. Looking at potential inefficiencies or bottlenecks in workflow formed the development of a strategic plan for improving GC workflows at the prenatal Genetics Clinic. Improvements suggested through this analysis were constrained to support the current number of healthcare providers working within the existing space configuration.

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“…Some QI methods that have been used to increase efficiency and reduce wait times include eliminating automatic rebooking or overbooking, adjusting the ratio of new patient visits to follow-up visits, and increasing the use of physician assistants (Flanary et al, 2020). The concept of Quality Improvement using structured methods began in the manufacturing industry and are now being applied to in healthcare (Lin et al, 2013).…”

Section: Common Approaches To Improve Clinical Workflowmentioning

confidence: 99%

Improving the Efficiency and Capacity of Virtual Genetics Clinics using Human Factors Design Methods

Attef¹

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The COVID-19 pandemic brought with it significant challenges for healthcare as well as some opportunities. The Prenatal Genetics Clinic at the Children's Hospital of Eastern Ontario (CHEO) in Ottawa moved to virtual care at the outset of the pandemic. Herein, we conducted a quality improvement study focused on developing a better understanding of factors influencing the efficiency of prenatal Genetics Counsellors (GCs) to support virtual care and related patient activities, with the intent of developing strategies to improve workflow. Within the context of the pandemic, we used remote and field methods of quantitative and qualitative inquiry to develop a better understanding of clinical workflows after the implementation of virtual care. This included diary studies to track time on task and naturalistic observation sessions at the Clinic. The Lean Improvement Approach was used to assess barriers to efficient workflows and develop recommendations for improvement. The analysis of GC's virtual and on-site workflows has increased our understanding of the work GCs perform, allowed us to define the challenges with virtual care experienced by GCs, and evaluate the existing processes to help identify systemic design problems and opportunities for improvement. The strategies suggested from this analysis fall within real-world project constraints, which included the inability to increase the number of GCs and inability to renovate the current clinic space. Our results show that GCs spend at least half of their time on patient-related tasks before and/or after the patient's appointment. Therefore, looking at potential inefficiencies or bottlenecks during these phases of work may help improve their overall workflow and flow through of patients. The results and recommendations that emerged were captured in a framework that identifies 3 key areas for strategic improvement measures -digital accommodation, administration support, and clinical assistance. iii Recommendations from the administrative and clinical assistance groups have already been implemented in the form of a new scheduling strategy and a new support staff role for clinical assistance. The remaining recommendations will support the on-going development of a strategic plan for improving work efficiency across the entire patient service unit of the Department of Genetics.

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Use of Lean Six Sigma to Improve Access to Care in a Surgical Subspecialty Clinic

Cited by 9 publications

References 14 publications

Effects of Six Sigma methodology on depression and anxiety of patients with end-stage renal disease

Effects of Six Sigma methodology on depression and anxiety of patients with end-stage renal disease

Improving Genetics Clinic Efficiency and Capacity Using Design and Human Factors Methods

Improving the Efficiency and Capacity of Virtual Genetics Clinics using Human Factors Design Methods

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