Abstract
Purpose :
Patient access to health care is an ongoing medical and public health challenge. This study explored whether the implementation of LEAN management could enhance patient flow through the ophthalmology clinic, increasing the ability of the clinic to see more patients and improving access to eye care.
Methods :
Data was collected at the University of Massachusetts Memorial Eye Center in Worcester, Massachusetts by using timesheets that were based on the different procedural phases patients go through while at the eye center. The time taken for the procedure and wait times from one task to the other were measured. The distance between tasks as well as the steps taken by the patients and the clinicians were recorded using a pedometer. This initial time study gave a baseline of patient flow and guided process changes that the clinic made. A weekly huddle was established to identify undesirable effects (UDEs) and review metrics. Tracking was repeated a year after the LEAN management principles were implemented. In addition to the two time studies, the volume of visits, the percent of new patients, and the percent of new patients scheduled within 14 days were extracted from the electronic medical record to measure access.
Results :
After the implementation of process improvements, there was a 12.16% decrease in the average total time a patient spent at the clinic from check-in to check-out, which is significant compared to the baseline study (t-test, tstat = 41.70, df = 2445, p < 0.0001, α = 0.05). The average amount of patients seen per doctor increased significantly by 18.27% (t-test, tstat = 2.15, df = 180, p = 0.03, α = 0.05). Additionally, there was an 12.60% increase in time the physician spent with the patient. Metrics of access also significantly improved as there was a 44% increase in mean volume of patients seen per month (t-test, tstat = 4.51, df = 4, p = 0.01, α = 0.05), a 13.5% increase in new patients (t-test, tstat = 5, df = 4, p = 0.007, α = 0.05), and a 166.90% increase in the amount of new patients scheduled within 14 days (t-test, tstat = 12.09, df = 4, p = 0.0003, α = 0.05).
Conclusions :
Implementation of LEAN principles improved patient flow and increased patient access to eye care. With more patients receiving adequate eye care, their health outcomes and quality of life can improve. Further studies, concerning healthcare access should be conducted to better improve our healthcare system.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.