Article Title

Scaling Lean in Primary Care and Impacts on Organizational Performance

Publication Date



lean process improvement, delivery systems


Background/Aims: Despite increasing adoption of lean practices in health care, there are few rigorous studies of its impacts on delivery system performance over time, particularly in fee-for-service ambulatory settings. This study examines the impact of lean implementation on performance metrics, including workflow efficiencies, physician productivity, cost, quality and satisfaction in primary care departments of a large ambulatory care delivery system.

Methods: This was an observational study of phased lean implementation among 328 physicians in 46 primary care departments housed within 17 geographically distinct clinic locations. Performance metrics included: workflow efficiency, productivity, operating expenses, clinical quality and patient, physician and staff satisfaction. Interrupted time series analysis using generalized linear mixed models was used to examine lean impacts on organizational performance over time.

Results: Systemwide improvements were observed in workflow efficiencies, physician productivity and clinical quality metrics (P < 0.05). Patient satisfaction with access to care, handling of personal issues and overall experience of care also increased, but decreased with respect to interactions with care providers (P < 0.05). Departmental operating costs decreased, though this was not statistically significant. Finally, annual staff and physician satisfaction scores increased in key domains, ranging from employee engagement and connection to purpose to relationships with staff and physician time spent working.

Conclusion: Lean system redesigns resulted in improvements on a variety of metrics ranging from provider workflow efficiencies to satisfaction among patients and staff. This study contributes to a currently sparse literature on the impact of lean in primary care. In examining a comprehensive set of performance metrics, our findings suggest several improvements in areas targeted by lean redesigns.




June 30th, 2016


August 12th, 2016