University of Minnesota Medical School.
Department of Urology, Naval Medical Center, San Diego.
Mil Med. 2020 Jun 8;185(5-6):e887-e893. doi: 10.1093/milmed/usz426.
At the Naval Medical Center San Diego urology clinic, patients reported waiting for greater than 1 month for an initial consult. A Lean Six Sigma approach was used to improve access to care (ATC) and decrease variation in access by improving scheduling.
A Define-Measure-Analyze-Improve-Control approach was used. Delay to new patient visits was identified as the focus of intervention. The scheduling template was changed from a fixed stream to a modified wave based on simulation software analysis of appointment cycle times. Appointment length was adjusted based on cycle time analysis, and two rooms per clinician were used instead of one. The ratio of initial consults relative to established follow-ups and procedures was adjusted upward to better balance with the historic demand.
Statistically significant improvement was seen in ATC and compliance with the Defense Health Agency (DHA) standard that new consults be seen within 28 days. Average days for a new consult to be seen were reduced by 7.2 days in the pediatric urology clinic (P < 0.0001) and 6.4 days in the adult urology clinic (P < 0.0001). Compliance with the Defense Health Agency 28-day ATC standard increased from a baseline of 69.2% to 88.9% and 61.7% to 84.4%, respectively, in the pediatric and adult clinics (P < 0.001 for both). Patient satisfaction was maintained at or above the goal threshold throughout the project.
An Lean Six Sigma model was used to improve timeliness of care for our patients, improving the overall quality of their healthcare experience. Simulation software can be used to model the clinic throughput and test alternative scheduling templates. ATC was significantly improved and patient satisfaction was maintained at or above goal thresholds.
在圣地亚哥海军医疗中心泌尿科诊所，患者报告说他们需要等待超过 1 个月才能进行初次就诊。采用精益六西格玛方法来改善医疗服务可及性并减少可及性的变异性，从而改善预约安排。
采用“定义-测量-分析-改进-控制”方法。将新患者就诊的延迟确定为干预的重点。预约模板从固定流改为基于预约周期时间模拟软件分析的修改波。根据周期时间分析调整预约时长，并为每位临床医生使用两个房间，而不是一个房间。将初始咨询相对于已建立的随访和程序的比例向上调整，以更好地与历史需求保持平衡。
在医疗服务可及性和符合国防卫生局（DHA）标准方面，新就诊应在 28 天内进行方面，取得了统计学上的显著改善。儿科泌尿科诊所（P < 0.0001）和成人泌尿科诊所（P < 0.0001）新就诊的平均天数分别减少了 7.2 天和 6.4 天。儿科和成人诊所分别将符合国防卫生局 28 天医疗服务可及性标准的比例从基线的 69.2%提高到 88.9%和 61.7%至 84.4%（两者均 P < 0.001）。在整个项目中，患者满意度保持在目标阈值或以上。
采用精益六西格玛模型来提高我们患者的医疗服务及时性，改善他们整体医疗保健体验的质量。可以使用仿真软件来模拟诊所吞吐量并测试替代的预约模板。医疗服务可及性得到了显著改善，患者满意度保持在目标阈值或以上。
