Purchase this article with an account.
Elizabeth Marlow, Lexi Robbins, Karim Hutton, Nicolette Aivazov, Stephanie Muylaert; Applying Lean process methodology to improve patient experience, quality outcomes, and staff and provider satisfaction in an academic glaucoma practice. Invest. Ophthalmol. Vis. Sci. 2017;58(8):5050.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Our primary aim was to improve patient experience, quality outcomes, and staff and provider satisfaction by reducing patient wait time and total length of visit by studying patient flow and the individual process steps of glaucoma clinic visits. Secondarily we hope to improve our Press-Ganey (PG) scores by addressing our office’s primary patient complaint: wait time. We estimated that up to 50% of a glaucoma patient’s total visit time was non-value added (NVA) time spent waiting, and that the visual field (VF) process step of a visit had the longest wait time.
This prospective, direct observational study evaluated 105 visits over 2 months to one physician’s glaucoma practice within an academic multispecialty group in New York City. Patient visits were subdivided by type: new patient visit, continuous care visit, follow-up, and pre- and post-operative. The office was subdivided so that each visit component could be accurately recorded using a tailored Lean time observation template. The time spent waiting for and performing each component were documented and analyzed.
Our time observations revealed that for all visits 54.5% of total visit length was NVA wait time, which is concordant with our PG feedback. There was a significant difference in visit duration based on appointment type. New patient visits were the longest appointments (mean 160 min, n=10) with a mean of 90 minutes spent in NVA wait time (56.3%). The most common type of appointment was a follow-up visit (n=45) with a mean visit time of 87.3 min and 47.1 min of NVA wait time (54.0%). VF was the longest process step (mean 18.5 ± 12.5 min, n=57) with an average wait time of 21.6 min (max=54 mins, n=57). Tech workup had the longest wait time overall of 24.5 min (n=102).
The Lean time observation template and basic data analysis and visualization demonstrate patient flow bottlenecks that confirmed our predictions that over 50% of a patient’s visit was NVA wait time and that VF was the longest process step. Overall, our study creates a simple, yet helpful model for determining the patient flow-limiting components of a glaucoma practice that could guide strategic and tactical changes to improve patient experience, quality outcomes, and staff and provider satisfaction in an academic glaucoma practice.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
This PDF is available to Subscribers Only