Implementation of Lean Methodology in a Free Clinic

  • Brett Aaron Cohen Medical College of Wisconsin
  • Michael Chris Decker Medical College of Wisconsin


Medical students have demonstrated difficulties performing their duties at the laboratory of a free clinic for the uninsured (SCU lab). This has a negative impact on patient care and patient safety as it results in longer clinic visit durations, as well as an increased number of laboratory-related errors. Our improvement project aims to use Lean principles derived from manufacturing industries in order to simplify and standardize the laboratory environment in an effort to increase performance of medical students and decrease wait times for patients in the laboratory setting.

Utilizing Lean methodology we can improve patient throughput. Our objective is to decrease the duration of time from patient entering the lab to leaving the lab by four minutes, decrease the number of patients needing more than two attempts to draw blood by 10%, and eliminate all laboratory-related errors.

We used process mapping, spaghetti diagrams, time studies and identification of waste opportunities to establish current-state conditions. Using root cause we implemented 5S organizational strategies in the work place to improve wastes identified. Students working in the lab were re-trained to the new process flow. The duration of patient encounters, the number of needle-sticks per patient, and laboratory-related errors were tracked through time studies.

In current-condition, a total of 39 patient encounters were tracked from May 10th – July 12th 2014. Average patient encounter duration was 15min 10sec, 21% of patients needed more than two attempts to obtain blood, and three laboratory-related errors occurred during this period. Seeking equipment and patient labels were largest opportunities for improvement. After implementing intervention, 29 patient encounters were tracked from July 19th – September 6th 2014. Average patient encounter duration was 10min 27sec, 10% of patients needed more than two attempts to obtain blood, and zero laboratory-related errors occurred during this period.

The implementation of 5S organizational strategies was shown to substantially decrease the duration of patient encounters and laboratory-related errors in the SCU lab. By implementing a simple and standardized process, medical students had greater success at performing their laboratory duties. This resulted in a positive impact on the patient experience at the SCU lab.

Author Biographies

Brett Aaron Cohen, Medical College of Wisconsin

M.D. Candidate Class of 2017

Saturday Free Clinic for the Uninsured, Laboratory Manager (2014-2015)

Michael Chris Decker, Medical College of Wisconsin

Professor, Department of Emergency Medicine

Chief Transformation Officer, Medical College of Wisconsin