• Transforming the Delivery of Care Within Outpatient Clinical Setting

Transforming the Delivery of Care Within Outpatient Clinical Setting


Neal R. Wendt, Fellow, Lean Healthcare Institute, American Epilepsy Institute, Austin, TX, USA


Outpatient, Primary Care, Secondary Care





This session is meant to serve as an outline and a structure for the implementation of Lean Principles in primary and secondary care environments in the transformation of the delivery of care.

There has never been a more important time in the United States for an overhaul on productivity and efficiency of the healthcare industry than there is today. Lean does not exist in the Healthcare industry in the primary and secondary care levels in the United States. This has led to numerous issues within the current US healthcare system, and an overall negative connotation with attending a doctor: the long-extended waiting, the repeating of issues, the lack of upfront information, getting sick at the doctor, lack of eye contact in conversation with the physician. This anguish has led to an increasing habit of missing out or skipping much needed medical care. With healthcare currently reaching 18% of the US economy coupled with our currently life expectancy fitting in just below that of Slovenia, the US has a major issue. The US has a healthcare cost that is double that of the Organization for Economic Co-operation and Development (OECD) average and unsustainable.

By identifying the value stream needed to produce only what is required for a patient in a primary and secondary healthcare entity a clinic can create a smooth continuous flow of products or services throughout its organization. The creation of this flow lends an organization to be able to identify extended wait times, or duplication of effort through the streamlined flow. The quest for the perfect process is the goal and the top pillar of any lean organization.

The biggest mistake that some people make is looking at Lean as only a set of tools or something that you do and then are done with – a bit like a project. Instead, the real gains come when it becomes a way of managing and is part of the fabric of a company. The five pillars of Lean, as stated by J Womack, are the building blocks to any Lean Process Improvement Program, with each one building collectively upon the next.

The principles at the core to Lean transformation were the same principles this speaker implemented while working with healthcare service companies. Empathy for the patient was at the core of everything they did, but it wasn't just caring for the patient in terms of wanting to heal them. It can be extremely difficult to look at the system through the eyes of someone who doesn’t experience the healthcare system every day, or as deeply as practitioners and care givers do. The developed expertise due to years of experience within the outpatient clinic setting blinded many of the staff and providers to the complete patient experience. The staff forgot that there is hesitation when seeing the doctor, that people are have a variety of several reasons that they walk through the glass doors of an outpatient clinic.

Understanding the vulnerabilities and the lack of healthcare knowledge from the customer’s perspective is critical to the full-spectrum delivery of empathetic care. Empathy for the patient is not only appropriate bedside manner, but also recognizing that each patient has a life outside the walls of the clinic. Not only are they in a vulnerable state when they come to the clinic, they are also dealing with the outside stresses of life. Imagine being left for an hour alone at a table in a restaurant or having a dry cleaner waiting room with no explanation of when the shirts are going to be delivered, only in a healthcare setting a person’s life might depend on it. Empathy for the patient extends beyond the delivery of good customer service and is at the center of Lean transformation for healthcare.