The best medical care in the world is only as good as the access a patient has to that care. At Kirklin Clinic, industrial engineers in the Performance Engineering department seek to improve patient access by focusing on better ways to increase efficiency, reduce healthcare costs and improve the overall patient experience.

"A lot of our projects are aimed at improving access: how do we get patients in to see the doctor in a more timely manner? Once they are in clinic, how can we get them through the clinic quicker, so they aren't waiting three hours and it's not an all-day visit," said Deborah Flint, senior director of Performance Engineering at The Kirklin Clinic of UAB Hospital.

One of the tools Flint and her colleagues use to improve the patient experience is a process improvement technique known as Lean Six Sigma (LSS).

"LSS is used in all sorts of industries. It has been adapted and is very popular in healthcare now," said J.M. "Mickey" Trimm, PhD, associate professor and director for the Center for Healthcare Management and Leadership at the UAB School of Health Professions. "Healthcare is moving from pay for procedure to pay for performance or pay for quality. In order for hospitals to be reimbursed at the highest level, they are going to have to prove and improve their existing quality levels. Healthcare organizations now need to look at what they do and how they do it, in order to do better."

When a hospital or clinic decides to employ LSS to improve one or more processes, a process improvement team is assigned. "The techniques take some time," Trimm said. "There is a lot of work that goes into analyzing, collecting information, studying, comparing processes and more. The processes that need to be improved are usually identified by the customers. A good example is doctor's offices where patients have to wait two to four hours before they get to see the doctor. That is a waste for the customer. It costs them money and creates a lack of satisfaction. Good physician practice groups will try to eliminate as much of that waiting time as possible."

In one project, Flint and her colleagues sought to reduce waiting time at Kirklin and tracked the results for a year. The team assigned to the project successfully streamlined the front desk check-in process, reducing process time by 26 percent and patient waiting time by 61 percent. The average time for patients waiting in the lobby before being placed in an exam room dropped from seven and a half minutes to two minutes, and total patient time in the clinic from arrival to departure dropped from 70 minutes to just under 55 minutes.

Flint said having the right people on the team was critical to the success of that project. "Having that group together really helped us drive change," she said. "We had senior leadership on board, which helped us remove barriers so we could move forward with the recommendations."

LSS is born out of Japanese process improvement ideas devised following World War II, so many of the terms used are Japanese in origin. People highly trained in LSS for over a year who learn to apply the concepts and demonstrate their ability can achieve black belt status in the field. Content experts in the medical field who are called upon to serve as team members can complete a five-day training experience and achieve a green belt. "These are people who are knowledgeable enough about process improvement techniques that they can use their content expert capabilities to apply with the LSS process," Trimm said.

Together, black belts and green belts can achieve needed change and improvements. The Performance Engineering Department consists of industrial engineers who don't interact directly with the patients, but Flint believes they play a key role at the clinic. "Healthcare has gotten very expensive, and we're trying to do our part," she said. "We may not be the one touching the patient, but if we can help that cancer patient not have to wait all day for something and make their time here more pleasant, we feel like we've done something to help."