Melanie Briscoe & Shaen Gingrich North East Specialized Geriatric Center

Lean Implementation in Health Care Using Value Stream Mapping

Problem Statement

Launch and Explore 

The problem was broken down into two main challenges: 1.) delivery and 2) preparation and were directly related to follow-up clinic time restraints which were causing longer wait times for patients and left clinicians feeling stressed and under pressure. 

  1. The Follow-up Clinic Delivery challenge left Clinicians frequently unable to complete their follow-up visits to the Manager of Clinical Services within the allocated 45-minute time frame. Clinicians reported feeling pressure because, if clinicians take longer than 45 minutes’ physicians are then behind for the duration of the day and the subsequent patients have an unexpected wait times.
  2. The Follow-up Clinic Preparation challenge steams from the inefficient process for preparing for follow up clinic. It took the majority of clinicians 30 minutes to prepare for each follow up patient. Clinicians reported that the increased time spent preparing for follow-up clinic has led to time constraints to complete other aspects of their role (e.g. allied health visits, professional development and capacity building). This is reflected in the clinician’s schedule tracked within the Electronic Medical Record (EMR). 



In order to address the follow-up clinic delivery challenge, a root causes analysis and Gemba walk was used to investigate and collect data on what was causing the clinicians to exceed the 45 minute time frame. Waste was discovered in the form of duplication as clinicians were collecting and filling out the same patient information upon each visit. With this information staff were able to develop and adopt new EMR forms/templates and procedure for follow-up clinic. The new form eliminated duplication as it had the capability to pull all previous information gathered into the EMR form.

The Follow-up Clinic Preparation challenge was explored using a value stream mapping (VSM) session. All stakeholders attended the VSM session where a current state of the processes was mapped out and waste or areas of improvement were identified. 

Once the process was mapped out it became clear that much of the information required for preparation was already found in the chart and required staff to locate and manually input this data into the form at each subsequent visit. Therefore, Staff then developed a future state map where all duplication of information was eliminated. In order to eliminate waste, new forms were developed. As a result staff estimated a 33% reduction in clinician’s preparation time from 30 minutes to 10 minutes per follow-up visit within 3 months


Using change management methods, all staff were able to adopt the new tools. The anticipated result was that that clinicians would be able to deliver their follow-up appointment within the 45-minute time allotment, thus reducing physician and patient delay and improving consistency. After a few months of change management and working closely with staff members’ resistant to change, NESGC was able to adopt the new forms and procedures and complete their follow-up visit within the allocated 45-minute time frame because they are now able to prioritize the content that is being gathered as a result of the guidelines and process that were built

Furthermore, the process for preparing for follow up clinic was successful in that the average amount of clinic preparation decreased from 30 minutes, which equated to $32,137.56/year, to 15 minutes per follow-up visit. This reduced the annual costs in half to $16,068.78/year. 

This case study is a great example of the value of the Plan Do Study Act Cycle, as going through this cycle the clinic was able to learn that the extra 5 minutes spent with the patients was value added and the goal of 10 minutes’ preparation time was adjusted to 15 minutes.  NESGC feels that the training overall was value added and this is only one small example of a project the clinic has completed with the Lean Green Belt Training.

Executive Summary

North East Specialized Geriatric Service Center (NESGC) is a healthcare provider who delivers specialized care for older adults with complex health needs throughout northeastern Ontario. NESGC used the PACE Lean approach to tackle 2 specific challenges clinicians were faced with. By using a variety of tools including an A3 assessment, Gemba walk and value stream mapping session, NESGC was able to identify the root cause of their problems, collect data and make an informed decision on how to identify and reduce waste in their workplace. The project resulted in a significant reduction in patient wait times as well as stress in the environment.