Use of lean sigma principles in a tertiary care otolaryngology clinic to improve efficiency

Sandra Y. Lin, Dean Gavney, Stacey L. Ishman, Julie Cady-Reh

Research output: Contribution to journalArticlepeer-review

30 Scopus citations


Objectives/Hypothesis To apply Lean Sigma, a quality-improvement strategy supported by tactical tools to eliminate waste and reduce variation, to improve efficiency of patient flow in a large tertiary otolaryngology clinic. The project goals were to decrease overall lead time from patient arrival to start of interaction with care provider, improve on-time starts of patient visits, and decrease excess staff/patient motion. Study Design Prospective observational study. Methods Patient flow was mapped through the clinic, including preregistration processes. A time-stamp observation study was performed on 188 patient visits over 5 days. Using Lean Sigma principles, time stamps were analyzed to identify patient flow constraints and areas for potential interventions. Interventions were evaluated and adjusted based on feedback from shareholders: removal of bottlenecks in clinic flow, elimination of non-value added registration staff tasks, and alignment of staff hours to accommodate times of high patient census. A postintervention time observation study of 141 patients was performed 5 months later. Results Patient lead time from clinic arrival to exam start time decreased by 12.2% on average (P =.042). On-time starts for patient exams improved by 34% (χ2 = 16.091, P <.001). Excess patient motion was reduced by 74 feet per patient, which represents a 34% reduction in motion per visit. Conclusions Use of Lean Sigma principles in a large tertiary otolaryngology clinic led to decreased patient wait time and significant improvements in on-time patient exam start time. Process mapping, engagement of leadership and staff, and elimination of non-value added steps or processes were key to improvement.

Original languageEnglish (US)
Pages (from-to)2643-2648
Number of pages6
Issue number11
StatePublished - Nov 2013


  • Lean
  • Six Sigma
  • ambulatory flow
  • clinic efficiency
  • clinic performance
  • outpatient clinic
  • patient flow

ASJC Scopus subject areas

  • Otorhinolaryngology


Dive into the research topics of 'Use of lean sigma principles in a tertiary care otolaryngology clinic to improve efficiency'. Together they form a unique fingerprint.

Cite this