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Translating 10 Lessons From Lean Six Sigma Project in Paper-Based Training Site to Electronic Health Record–Based Primary Care Practice: Challenges and Opportunities

Aleem, Sohaib MD, MPH

doi: 10.1097/QMH.0b013e31829a6b9a
Original Articles

Lean Six Sigma is a well-proven methodology to enhance the performance of any business, including health care. The strategy focuses on cutting out waste and variation from the processes to improve the value and efficiency of work. This article walks through the journey of “green belt” training using a Lean Six Sigma approach and the implementation of a process improvement project that focused on wait time for patients to be examined in an urban academic primary care clinic without requiring added resources. Experiences of the training and the project at an urban paper-based satellite clinic have informed the planning efforts of a data and performance team, including implementing a 15-minute nurse “pre-visit” at primary care sites of an accountable care organization.

Geisel School of Medicine and General Internal Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire.

Correspondence: Sohaib Aleem, MD, MPH, 1 Medical Center Dr, Lebanon, NH 03756 (

Funding for green belt LSS training was provided by the Social and Preventive Medicine Residency Program, University at Buffalo, New York.

The author declares no conflicts of interest.

The authors thank the following persons for their help in the preparation of the manuscript: Michael F. Noe, MD, MPH, The Social and Preventive Medicine Residency Program, Buffalo, NY—For providing funds for Lean Six Sigma (LSS) green belt training through residency and constant administrative support for the project in Buffalo, New York; Thom Marra, Certified Six Sigma Master Black belt from The Center for Industrial Effectiveness, Buffalo, New York: For kind guidance and coaching for the project; and team members: Christopher Schaeffer, MD (champion), Allison Raffaele, Karen Wright, Sharon Watson, Maria Ottaviano, and Terrie Schiavoni for kind input and support of the project at Hertel Elmwood Internal Medicine Clinic (HEIMC), Buffalo, New York.

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