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Vesper Williams, Phyllis Summerfelt, Tracy Kaczanowski, Krissa Packard, Diane Bishop, Mara Goldberg, Alfredo Dubra, Joseph Carroll, Aneesh Suneja; Applying Lean Principles to Clinical and Translational Research in Ophthalmology. Invest. Ophthalmol. Vis. Sci. 2013;54(15):4391.
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Lean is a philosophy that considers the expenditure of resources for any goal other than the creation of value to be wasteful. Originally applied in the manufacturing sector, lean methodologies have more recently been applied to a wide range of clinical operations, often focusing on decreasing patient wait times and improving and standardizing process flow. With an increased focus on translational research at academic medical centers, there is increased demand on exceedingly finite clinical resources to serve both clinical and research needs. Here we applied lean to identify, evaluate, and improve our research infrastructure on both strategic and operational levels.
We established a core team consisting of research coordinators, administrative personnel, research faculty, a research photographer, and a lean consultant. We undertook a quantitative evaluation of the existing research infrastructure within our clinical trials unit and Advanced Ocular Imaging Program. We mapped the flow of 35 research subjects, tracking movement as well as value-added and wasted (non-value added) times. We also examined the current overlap of resources, including equipment, space, and personnel. Finally, we presented preliminary findings to other stakeholders within the organization, in order to raise awareness and work towards achieving strategic alignment.
Total wasted time ranged 8-103 minutes per visit. On average, this comprised 25% of total visit time, with wait times comprising up to 59% of total visit time. Sources of waste included decentralized resources resulting in unnecessary movement, the need to wait for clinical equipment to become available, and utilization of clinical personnel as study staff - posing an inherent conflict. Competition for resources negatively impacts research subjects but also places significant strain on clinical personnel, resulting in predominantly negative attitudes towards research as a priority.
Our analysis identified numerous opportunities to improve the overall efficiency of research within our department. This has led to focused efforts to create parallel resources dedicated to research, including new staff, imaging equipment, and space. These modifications are expected to generate increased capacity for subject throughput. To our knowledge, this is the first report of lean application to an ophthalmic research environment.
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