Patient access and clinical efficiency improvement in a resident hospital-based women's medicine center clinic

Am J Manag Care. 2007 Dec;13(12):686-90.


Objectives: To apply the Six Sigma tools of Change Acceleration Process and Work-Out and to improve patient access in an outpatient clinic in a hospital-based residency training program.

Study design: Observational study.

Methods: Comparison of productivity in an obstetrics and gynecology clinic after implementation of the Six Sigma principles, with a comparable internal medicine clinic as a control group. Productivity from January 1 through December 31, 2005, was assessed in both clinics. After applying the Six Sigma tools to obstetrics and gynecology, outputs from both clinics from January 1 through December 31, 2006, were analyzed.

Results: Wait times for new obstetrical visits decreased from 38 to 8 days. The patient time spent in the clinic dropped from 3.2 to 1.5 hours. Initial gynecologic visits increased by 87% (from 453 to 850 per year), return gynecologic visits increased by 66% (from 1392 to 2311 per year), initial obstetrical visits increased by 55% (from 520 to 808 per year), repeat obstetrical visits increased by 45% (from 2239 to 3243 per year), and the mean patient satisfaction scores increased from 5.75 to 8.54 (on a 10-point scale). The gross clinic revenue increased by 73% in the first 6 months of 2006 over that of the previous year. By contrast, internal medicine patient wait times for new patients and for revisits, patient satisfaction scores, total number of clinic visits, and revenues remained unchanged.

Conclusion: Application of the Six Sigma principles resulted in a team approach to solving the clinic's productivity issues.

MeSH terms

  • Appointments and Schedules
  • Case-Control Studies
  • Efficiency, Organizational*
  • Female
  • Health Services Accessibility / standards*
  • Humans
  • Internal Medicine / organization & administration
  • Internal Medicine / statistics & numerical data
  • Management Audit
  • Maternal Health Services / organization & administration
  • Maternal Health Services / statistics & numerical data*
  • Models, Organizational
  • Outpatient Clinics, Hospital / organization & administration
  • Outpatient Clinics, Hospital / statistics & numerical data*
  • Process Assessment, Health Care
  • Time Factors
  • Waiting Lists
  • West Virginia