Improving Performance in Primary Care

Lean is a performance improvement strategy that emphasizes reducing waste, with waste defined as activity that adds less value than it costs. Examples of waste include patients’ waiting time (which adds no value from their perspective), staff looking for supplies, staff who are not using all their skills, and unnecessary paperwork.

The Lean approach stresses increasing efficiency and redesigning products so that they meet customers’ goals better. Does Lean reduce costs in primary care? Does it improve customer satisfaction? Does it improve staff satisfaction? Does it improve clinical quality? California’s Palo Alto Medical Foundation for Health Care, Research and Education (which has more than 1,400 physicians and more than 5,000 other employees) systematically evaluated its systemwide Lean initiative to find out.

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This initiative standardized the equipment, supplies, and educa- tion materials in exam rooms; set up shared work spaces for physi- cians and staff; and redesigned multiple workflows. For example, teams started daily morning huddles to review schedules, expanded the roles of medical assistants, and established metrics to track clini- cal quality, costs, patient satisfaction, staff satisfaction, and physi- cian satisfaction. Most measures of clinical quality did not change, although diabetes care improved. Costs dropped, patient satisfaction increased, staff satisfaction increased, and physician satisfaction did not change

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