Use of Lean Management to Increase Efficiency and Osteopathic Manipulative Treatment in a Family Medicine Residency

Objectives: To determine Lean management's ability to improve the efficiency of residents and increase osteopathic manipulative treatment (OMT) in a family medicine residency clinic.  Methods: A Key Performance Indicator Board (KPI), a process of Lean management, was created in a residency clinic by various staff. Patient wait times were chosen for the quality measure and daily huddles took place to track progress. A “5-why” was conducted to determine the reasons for failure to meet goals. Faculty used this information to create the 5 “S” of Efficiency method to help residents improve timeliness in caring for complicated patients. Comparisons of the number of patient visits failing wait time goals and total OMT performed before and after the intervention was analyzed. Chi-square was used for statistical analysis and the p-value was set at 0.05.  Results: Implementation of the 5 “S” of Efficiency method resulted in a significantly lower percentage of days failing the wait time goal in comparison to months before the intervention (p = 0.00001): the average percentage of failed days decreased from 43.1% to 10.4% with the intervention. Enacting Lean management also resulted in a significantly greater percentage of billed OMT billing codes (6.8% vs. 5.3%) (p = 0.03).  Conclusion: This study indicates that the use of Lean may reduce patient wait times and lead to increased OMT use among family medicine residents. Use of Lean or the 5 “S” of Efficiency method may help other osteopathic programs attempting to improve care; however, further research is indicated.