Using the LEAN process in Public Health: Improving operations by eliminating waste

Denver Public Health participates in Denver Health‘s LEAN systems initiative, implementing a systematic approach to identify and eliminate waste (non-value-added activity) through continuous process improvement to optimize patient care and staff satisfaction. Introduced by Toyota and implemented by organizations such as Ritz-Carlton, LEAN provides tools for teams to undertake structured improvement cycles that identify the reason for action, perform on-site observation, employ rapid and iterative improvement experiments, and create standard work that is sustainable. Since 2006, Denver Public Health has used LEAN tools and events within clinic, programmatic and administrative settings to improve patient access and the patient experience, save space and staff positions, increase staff productivity and satisfaction, and reduce expenses. In 2009 alone, approximately $120,000 was saved using LEAN processes, and additional service was provided utilizing the same staffing resources. For example, the Tuberculosis Clinic, with the help of trained Public Health LEAN facilitators and LEAN tools, analyzed and streamlined the patient intake appointment and call-back process, improving patient flow through registration, blood-draw, testing, nurse visits and patient re-appointments. These changes reduced patient wait time by two-thirds, increased staff communication, reduced staff stress, eliminated unnecessary process steps, and allowed the clinic to reallocate a vacant staff position to an area that had a staffing shortage. A comparable improvement process was undertaken in the STD Clinic, providing appointments and reducing wait times. Using the LEAN process in Public Health has enhanced team work, improved the patient experience, enhanced staff participation, communication and satisfaction, and increased productivity without increasing resources.