Patient experiences after implementing lean primary care Redesigns

Objective: To examine the effect of Lean primary care redesigns on patient satisfaction with care and timeliness of care received. Data/Setting: We used patient surveys and time-stamped electronic health record (EHR) data in a large ambulatory care system. Design: Lean-based changes to clinical spaces and care team workflows were implemented in one pilot site and then scaled to all primary care departments across the system. Redesigns included standardizing equipment and patient education materials in examination rooms, streamlining call management functions, co-locating physician and medical assistant dyads in a shared workspace, and creating new care team workflows. We used a non-randomized stepped-wedge study design and segmented regression with interrupted time series analysis to examine Lean Impacts on patient outcomes. Data Collection: We analyzed patient satisfaction ratings and wait times as documented by the EHR. These longitudinal data were collected for 317 physician-led teams in 46 primary care departments from January 2011 to December 2016. Principal Findings: After implementation of Lean redesigns, patients reported a 44.8 percent increase in satisfaction with the adequacy of time spent with care providers during office visits (P Conclusions: Patient experiences of care after Lean implementations have not been widely studied in primary care settings. We found that Lean redesign yielded improvements that may strengthen clinical operations while enhancing value for patients. KEYWORDS lean implementation, longitudinal time-stamped EHR data, patient satisfaction/experiences, quality improvement, stepped-wedge study design, timeliness of care
1 INTRODUCTION Self-reported patient experiences of care are important indicators of the quality of primary care delivery. Perceived connectedness with physicians and degree of care continuity are associated with higher [...]