Applying Lean Six Sigma methodologies to improve efficiency, timeliness of care, and quality of care in an internal medicine residency clinic

Qual Manag Health Care. 2010 Jul-Sep;19(3):201-10. doi: 10.1097/QMH.0b013e3181eece6e.


Objective: Patients' connectedness to their providers has been shown to influence the success of preventive health and disease management programs. Lean Six Sigma methodologies were employed to study workflow processes, patient-physician familiarity, and appointment compliance to improve continuity of care in an internal medicine residency clinic.

Methods: We used a rapid-cycle test to evaluate proposed improvements to the baseline-identified factors impeding efficient clinic visits. Time-study, no-show, and patient-physician familiarity data were collected to evaluate the effect of interventions to improve clinic efficiency and continuity of medical care.

Results: Forty-seven patients were seen in each of the intervention and control groups. The wait duration between the end of triage and the resident-patient encounter was statistically shorter for the intervention group. Trends toward shorter wait times for medical assistant triage and total encounter were also seen in the intervention group. On all measures of connectedness, both the physicians and patients in the intervention group showed a statistically significant increased familiarity with each other.

Conclusion: This study shows that incremental changes in workflow processes in a residency clinic can have a significant impact on practice efficiency and adherence to scheduled visits for preventive health care and chronic disease management. This project used a structured "Plan-Do-Study-Act" approach.

Publication types

  • Evaluation Study

MeSH terms

  • Appointments and Schedules
  • Case-Control Studies
  • Disease Management
  • Efficiency, Organizational*
  • Humans
  • Internal Medicine / organization & administration*
  • Internship and Residency
  • Patient Care / standards
  • Patient Compliance
  • Physician-Patient Relations
  • Primary Health Care / organization & administration*
  • Primary Health Care / standards
  • Process Assessment, Health Care*
  • Quality of Health Care*
  • Time Factors
  • Time and Motion Studies
  • Waiting Lists
  • Workflow*