Utilitizing Lean Process for Quality Improvment in an Ambulatory Urgent Care Setting

Purpose:
Integrate Lean methodology to improve quality, financial, and operational efficiency by decreasing average length of stay (LOS), improving patient satisfaction, decreasing patients left without being seen (LWBS), decreased costs, and increased revenue

Significance:
Prolonged wait time is a patient dissatisfier and reduces quality of care. For example, patients with asthma seeking care at this urgent care center often required increased LOS after waiting for care. Improved clinic finances allow this safety-net medical system to provide care to more patients.

Strategy and Implementation:
The Lean improvement system facilitated collaboration between all levels of care providers on the team, including RNs, NPs, PAs, and MDs. Relocation and revamp of the clinic's fast track allowed for the creation of a self-contained flow-cell, which reduced non-value-added activities for patients. In addition the team updated standard work in all areas, including update of lab tests ordered based on current evidence and clinical assessment. RNs provided in-room screening, which allowed for earlier recognition of disease process and earlier intervention. Computerized standardized discharge forms were also implemented.

Evaluation:
The collaborative environment enabled providers to increase the number of patients seen from 2.4 to 3 per hour in the fast track, a financial gain of $86,000 in 1 year. The 23% decrease in LOS allowed for a 14% increase in visits, a 25% decrease in LWBS, and a 75% decrease in patient complaints.

Implications for Practice:
Using Lean as a quality improvement tool, the team redefined the clinic's mission to facilitate a collaborative process to best serve urgent-care patients. As a result the team is able to facilitate timely, quality, cost efficient care for the people of Denver.