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Lean Transformation of the Eye Clinic at The Hospital for Sick Children: Challenging an Implicit Mental Model and
Agnes M F Wong1, David During2, Michael Hartman3
1Ophthalmologist-in-chief and John & Melinda Thompson Chair in Vision Neurosciences at The Hospital for Sick Children, as well as professor of Ophthalmology and Vision Sciences at University of Toronto.
Insights
Lean principles reduced patient dwell time by 26% in an eye clinic, increasing valuable patient-provider time. This study shows how data can challenge healthcare assumptions and improve systems.
Area of Science:
- Healthcare Management
- Process Improvement
- Systems Thinking
Background:
- Long patient dwell times present a significant challenge in healthcare settings.
- Existing healthcare systems often operate on unexamined assumptions and heuristics.
- Inefficient patient flow impacts both patient experience and resource utilization.
Purpose of the Study:
- To apply Lean principles to reduce patient dwell time in an eye clinic.
- To increase the proportion of value-added time during patient visits.
- To demonstrate how objective data can inform and reshape mental models within healthcare systems.
Main Methods:
- Implementation of Lean principles focused on waste elimination and flow enhancement.
- Systematic data collection and analysis of patient dwell time and value-added time.
- Challenging implicit assumptions through objective data to foster a new conceptual framework.
Main Results:
- Achieved a 26% reduction in mean patient dwell time over eight months.
- Increased average patient time with healthcare providers (value-added time) from 21% to 31%.
- Demonstrated the feasibility of data-driven mental model shifts for system improvement.
Conclusions:
- Lean principles are effective in reducing patient dwell time and enhancing healthcare efficiency.
- Objective data is crucial for identifying and correcting flawed assumptions in healthcare delivery.
- A new, data-informed mental model can lead to significant improvements in healthcare systems and patient care.
Abstract:
Long patient dwell time (i.e., the time between patients arriving and leaving the clinic) has been a long-standing issue in the eye clinic at The Hospital for Sick Children. By applying the Lean principles of eliminating waste and enhancing flow, we achieved a 26% reduction in the mean patient dwell time over an eight-month period. Importantly, the average time a patient spent with healthcare providers (value-added time) increased from 21% to 31%. In this paper, we summarized our experience by illustrating how an implicit mental model (conscious or unconscious conceptual framework from which we understand the world) pervades in the healthcare system based on deeply held but unexamined assumptions that arise from heuristics (general rules of thumb) and biases; how these assumptions can be tested by objective data; and how we can build a new mental model based on objective findings to improve the healthcare system.
