Process improvement of pap smear tracking in a women's medicine center clinic in residency training.

Application of Six-Sigma methodology and Change Acceleration Process (CAP)/Work Out (WO) tools to track pap smear results in an outpatient clinic in a hospital-based residency-training program. Observational study of impact of changes obtained through application of Six-Sigma principles in clinic process with particular attention to prevention of sentinel events. Using cohort analysis and applying Six-Sigma principles to an interactive electronic medical record Soarian workflow engine, we designed a system of timely accession and reporting of pap smear and pathology results. We compared manual processes from January 1, 2007 to February 28, 2008 to automated processes from March 1, 2008 to December 31, 2009. Using the Six-Sigma principles, CAP/WO tools, including "voice of the customer" and team focused approach, no outlier events went untracked. Applying the Soarian workflow engine to track prescribed 7 day turnaround time for completion, we identified 148 pap results in 3,936, 3 non-gynecological results in 15, and 41 surgical results in 246. We applied Six-Sigma principles to an outpatient clinic facilitating an interdisciplinary team approach to improve the clinic's reporting system. Through focused problem assessment, verification of process, and validation of outcomes, we improved patient care for pap smears and critical pathology.

Patient access and clinical efficiency improvement in a resident hospital-based women's medicine center clinic.

OBJECTIVES: To apply the Six Sigma tools of Change Acceleration Process and Work-Out and to improve patient access in an outpatient clinic in a hospital-based residency training program. STUDY DESIGN: Observational study. METHODS: Comparison of productivity in an obstetrics and gynecology clinic after implementation of the Six Sigma principles, with a comparable internal medicine clinic as a control group. Productivity from January 1 through December 31, 2005, was assessed in both clinics. After applying the Six Sigma tools to obstetrics and gynecology, outputs from both clinics from January 1 through December 31, 2006, were analyzed. RESULTS: Wait times for new obstetrical visits decreased from 38 to 8 days. The patient time spent in the clinic dropped from 3.2 to 1.5 hours. Initial gynecologic visits increased by 87% (from 453 to 850 per year), return gynecologic visits increased by 66% (from 1392 to 2311 per year), initial obstetrical visits increased by 55% (from 520 to 808 per year), repeat obstetrical visits increased by 45% (from 2239 to 3243 per year), and the mean patient satisfaction scores increased from 5.75 to 8.54 (on a 10-point scale). The gross clinic revenue increased by 73% in the first 6 months of 2006 over that of the previous year. By contrast, internal medicine patient wait times for new patients and for revisits, patient satisfaction scores, total number of clinic visits, and revenues remained unchanged. CONCLUSION: Application of the Six Sigma principles resulted in a team approach to solving the clinic's productivity issues.