Using lean thinking at an otorhinolaryngology outpatient clinic to improve quality of care

J.E. van Leijen-Zeelenberg*, Jan Wouter Brunings, I. Houkes, A.J.A. van Raak, D. Ruwaard, H.J.M. Vrijhoef, B. Kremer

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Objectives/HypothesisAlthough Lean Thinking has led to considerable improvement in a variety of healthcare settings, its effects on otorhinolaryngology remain underexposed. This study reports on how the implementation of Lean Thinking at an otorhinolaryngology outpatient clinic has affected patient and provider satisfaction, waste reduction, and organizational culture.

Study DesignProspective before-and-after design.

MethodsThe 18-month prospective before-and-after design used mixed methods for data collection and analysis. A survey was conducted to measure satisfaction among patients and providers. Semistructured interviews were conducted to evaluate the effect of Lean Thinking on waste and organizational culture.

ResultsDuring the project, 69 issues were posted on the Lean board. Improvements were made on 36 inefficiency issues, not all concerning a specific type of waste. Employees reported considerable improvement in transportation, motion, and waiting. Patient satisfaction was high both at baseline and follow-up and did not change significantly. The effects on provider satisfaction were slight; satisfaction with autonomy and participation decreased significantly, but satisfaction with communication increased significantly.

ConclusionsThe implementation of Lean Thinking at an otorhinolaryngology outpatient clinic reduced waste and increased provider satisfaction with communication. Although patient satisfaction did not change significantly, it cannot be concluded that the intervention had no effect on perceived quality of care. Other approaches to measure patients' perceptions should be considered.

Level of EvidenceNA Laryngoscope, 126:839-846, 2016

Original languageEnglish
Pages (from-to)839-846
Number of pages8
Issue number4
Early online date3 Nov 2015
Publication statusPublished - Apr 2016


  • Quality improvement
  • otolaryngology
  • outpatient clinic
  • Lean Thinking
  • mixed methods
  • COST

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