Thinking lean: implementing DMAIC methods to improve efficiency within a cystic fibrosis clinic.

The timely coordination of care in clinics that require frequent assessments by multiple specialists can be challenging for both patients and providers. The cornerstone of care at cystic fibrosis (CF) centers with superior clinical outcomes, as with reduced acuity of episodic disease and incidence of hospitalizations, is frequent clinical encounters coupled with aggressive therapies. However, inefficiencies in the clinical practice structure prevent optimal utilization of resources. To decrease non-value-added time, defined as time a patient spends alone in an examination room, without altering the time providers spend caring for a patient, the application of Lean methods was used to see whether reducing variation could significantly decrease lead time, considered the length of a patient visit, within a CF clinic setting. Baseline capability analyses revealed only 19.3% of patient visits were completed in 60min or less, with mean and median visit times of 84 and 81min, respectively. Final capability analyses demonstrated that 41.5% of patient visits were completed in 60min or less, 23% greater than the baseline capability. Mean and median visit times decreased by 10min per visit. Research efforts increased the available capacity by 500 patient visits per year, representing additional revenue of over US$165,000 annually with no additional administrative costs incurred.