Optimizing Clinic Efficiency and Patient Flow in an Outpatient General Surgery Clinic

Background: Clinic workflow efficiency influences patient and employee satisfaction, impacting effective delivery of care. Utilizing lean methodology, we aim to increase the percentage of patients seen within 15 minutes of scheduled appointment to 75% and reduce nonvalue-added time (NVT) per visit by half within 6 months. Methods: Frontline stakeholders observed workflow inefficiencies in an outpatient general surgery clinic, leading to long wait times and generalized dissatisfaction. From August to September 2023, patient and staff flow was captured and appointment component time intervals observed. Only 35.8% of patients were seen within 15 minutes of appointment, with median appointment-to-seen time (AST) 19.00 minutes and NVT 74%. Interventions were implemented through progressive plan-do-study-act (PDSA) cycles, including changes to workflow, rooming, and scheduling template. Appointment time interval data were collected and analyzed using run charts. Results: PDSA 1 yielded median AST of 15.68 minutes, with 51.7% of patients seen within 15 minutes of appointment. PDSA 2 resulted in a median AST of 8.00 minutes, with 66.4% of patients seen within 15 minutes of appointment and reduced median NVT from 74% to 55.9%. Late in PDSA 2 in December, when the clinic was short-staffed, both median AST and NVT increased. PDSA 3 resulted in reduced median AST of 5.00 minutes, with 82.9% of patients seen within 15 minutes of appointment and reduced median NVT to 51.5%, with improved performance stability particularly with respect to AST. Conclusions: Utilization of lean methodology with multiple targeted workflow and scheduling interventions resulted in improved efficiency in an outpatient general surgery clinic.