Implementing Lean in Academic Primary Care

作者：Daaleman Timothy P; Brock Dawn; Gwynne Mark; Weir Sam; Dickinson Iris; Willis Beth; Reid Alfred

来源：Quality Management in Health Care, 2018, 27(3): 111-116.

DOI：10.1097/QMH.000000000000173

• implementation
• Lean
• medical home
• primary care
• quality improvement

Background: Lean is emerging as a quality improvement (QI) strategy in health care, but there has been minimal adoption in primary care teaching practices. This study describes a strategy for implementing Lean in an academic family medicine center and provides a formative assessment of this approach. Methods: A case study of the University of North Carolina Family Medicine Center that used the Consolidated Framework for Implementation Research to guide a formative evaluation. The implementation strategy included partnering with Lean content experts and creating a leadership team; planning and completing QI events and Lean training modules; and evaluating and reporting activities related to QI and training. Results: During the initial period of Lean implementation, there was (1) minimal to no change in the quality of care as determined by the Preventive Care Index (46-48); (2) a decrease patient appointment cycle time from 89 minutes to 65 minutes; (3) an increase in overall practice productivity from $8144 to $9160; (4) a decrease in patient satisfaction from 94% to 91%; and (5) an increase in monthly visit volume from 4112 to 5076. Conclusion: Lean had an uneven effect on QI in an academic primary care practice during the first year of implementation.

• 出版日期2018-9