Get access

Use of lean sigma principles in a tertiary care otolaryngology clinic to improve efficiency


  • The authors have no funding, financial relationships, or conflicts of interest to disclose.



To apply Lean Sigma, a quality-improvement strategy supported by tactical tools to eliminate waste and reduce variation, to improve efficiency of patient flow in a large tertiary otolaryngology clinic. The project goals were to decrease overall lead time from patient arrival to start of interaction with care provider, improve on-time starts of patient visits, and decrease excess staff/patient motion.

Study Design

Prospective observational study.


Patient flow was mapped through the clinic, including preregistration processes. A time-stamp observation study was performed on 188 patient visits over 5 days. Using Lean Sigma principles, time stamps were analyzed to identify patient flow constraints and areas for potential interventions. Interventions were evaluated and adjusted based on feedback from shareholders: removal of bottlenecks in clinic flow, elimination of non–value added registration staff tasks, and alignment of staff hours to accommodate times of high patient census. A postintervention time observation study of 141 patients was performed 5 months later.


Patient lead time from clinic arrival to exam start time decreased by 12.2% on average (P = .042). On-time starts for patient exams improved by 34% (χ2 = 16.091, P < .001). Excess patient motion was reduced by 74 feet per patient, which represents a 34% reduction in motion per visit.


Use of Lean Sigma principles in a large tertiary otolaryngology clinic led to decreased patient wait time and significant improvements in on-time patient exam start time. Process mapping, engagement of leadership and staff, and elimination of non–value added steps or processes were key to improvement.

Level of Evidence

4. Laryngoscope, 123:2643–2648, 2013