Scaling Lean in primary care: impacts on system performance.

Area of Science:

• Healthcare Management
• Process Improvement
• Ambulatory Care

Background:

• Lean methodology is a strategy to enhance efficiency and patient value.
• Implementation and scaling across primary care clinics in a nonprofit, ambulatory care delivery system were examined.

Purpose of the Study:

• To examine performance outcomes after Lean methodology implementation.
• To assess the impact of Lean-based redesigns on operational metrics in primary care.

Main Methods:

• A stepped wedge approach was used across 46 primary care departments in 17 clinic locations.
• Longitudinal analysis of workflow efficiency, physician productivity, operating expenses, clinical quality, and patient/physician/staff satisfaction.
• Interrupted time series analysis with generalized linear mixed models was employed.

Main Results:

• Systemwide improvements in workflow efficiencies and physician productivity were observed.
• No adverse effects on clinical quality; patient satisfaction increased in access, personal issue handling, and overall experience.
• Departmental operating costs decreased; staff and physician satisfaction increased, particularly among early adopters.

Conclusions:

• Lean redesigns benefit primary care patients, physicians, and staff without negatively impacting clinical care quality.
• Results may encourage other delivery system leaders to adopt Lean techniques.
• Findings may enhance support for Lean learning among payers.