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Implementing Lean in Academic Primary Care

Daaleman, Timothy P., DO, MPH; Brock, Dawn, MPA; Gwynne, Mark, DO; Weir, Sam, MD; Dickinson, Iris, MPA; Willis, Beth, MPA; Reid, Alfred, MA

doi: 10.1097/QMH.0000000000000173
Quality Management in Primary Care

Background: Lean is emerging as a quality improvement (QI) strategy in health care, but there has been minimal adoption in primary care teaching practices. This study describes a strategy for implementing Lean in an academic family medicine center and provides a formative assessment of this approach.

Methods: A case study of the University of North Carolina Family Medicine Center that used the Consolidated Framework for Implementation Research to guide a formative evaluation. The implementation strategy included partnering with Lean content experts and creating a leadership team; planning and completing QI events and Lean training modules; and evaluating and reporting activities related to QI and training.

Results: During the initial period of Lean implementation, there was (1) minimal to no change in the quality of care as determined by the Preventive Care Index (46-48); (2) a decrease patient appointment cycle time from 89 minutes to 65 minutes; (3) an increase in overall practice productivity from $8144 to $9160; (4) a decrease in patient satisfaction from 94% to 91%; and (5) an increase in monthly visit volume from 4112 to 5076.

Conclusion: Lean had an uneven effect on QI in an academic primary care practice during the first year of implementation.

Department of Family Medicine, University of North Carolina at Chapel Hill (Drs Daaleman, Gwynne, and Weir and Mr Reid); Bryan Health System, Lincoln, Nebraska (Ms Brock); and Department of Operational Efficiency, University of North Carolina Hospitals, Chapel Hill (Mss Dickinson and Willis).

Correspondence: Timothy P. Daaleman, DO, MPH, Department of Family Medicine, University of North Carolina at Chapel Hill, Campus Box 7595, Chapel Hill, NC 27514 (

The authors declare no conflicts of interest.

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