ArticleJournal of general internal medicine2021
Implementing Lean Quality Improvement in Primary Care: Impact on Efficiency in Performing Common Clinical Tasks.
Article in Journal of general internal medicine, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
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Who cites it
9 citing papers in PubMed.
- Addressing Social and Cultural Needs with Lean Management in a National Sample of US Physician Practices.The Milbank quarterly · 2026Article
- Lean management of crisis response and post-pandemic outcomes in US primary care practices.BMC health services research · 2026Article
- A plan to transform primary and community care at Catalonia based on a process improvement methodology.Primary health care research & development · 2024Article
- The Impact of Pandemic-Driven Care Redesign on Hospital Efficiency.Risk management and healthcare policy · 2024Review
- Revisiting the Time Needed to Provide Adult Primary Care.Journal of general internal medicine · 2023Article
- How digital health documentation transforms professional practices in primary healthcare in Denmark: A WPR document analysis.Nursing inquiry · 2023Article
- Determinants for scalable adoption of autonomous AI in the detection of diabetic eye disease in diverse practice types: key best practices learned through collection of real-world data.Frontiers in digital health · 2023Review
- Road to Better Work-Life Balance? Lean Redesigns and Daily Work Time among Primary Care Physicians.Journal of general internal medicine · 2022Observational
- Prescription Renewal Request Reviews by Student Pharmacists in a Family Medicine Clinic.Pharmacy (Basel, Switzerland) · 2021Article
Corrections and comments
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Authors and funding
3 authors.
Funding
Abstract
backgroundMany primary care practices have adopted Lean techniques to reduce the amount of time spent completing routine tasks. Few studies have evaluated both immediate and sustained impacts of Lean to improve this aspect of primary care work efficiency.
objectiveTo examine 3-year impacts of Lean implementation on the amount of time taken for physicians to complete common clinical tasks.
designNon-randomized stepped wedge with segmented regression and interrupted time series analysis (January 2011-December 2016).
participantsA total of 317 physician-led teams in 46 primary care departments in a large ambulatory care delivery system.
interventionLean redesign was initiated in one pilot site followed by system-wide spread across all primary care departments. Redesigns included standardization of exam room equipment and supplies, streamlining of call management processes, care team co-location, and team management of the electronic inbox. MEASURES: Time-stamped EHR tracking of physicians' completion time for 4 common tasks: (1) office visit documentation and closure of patient charts; (2) telephone call resolution; (3) prescription refill renewal; and (4) response to electronic patient messages.
resultsAfter Lean implementation, we found decreases in the amount of time to complete: office visit documentation (- 29.2% [95% CI: - 44.2, - 10.1]), telephone resolution (- 22.2% [95% CI: - 38.1, - 2.27]), and renewal of prescription refills (- 2.96% per month [95% CI: - 4.21, - 1.78]). These decreases were sustained over several years. Response time to electronic patient messages did not change significantly.
conclusionsLean redesigns led to improvements in timely completion of 3 out of 4 common clinical tasks. Our findings support the use of Lean techniques to engage teams in routine aspects of patient care. More research is warranted to understand the mechanisms by which Lean promotes quality improvement and effectiveness of care team workflows.
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