191 they reported they achieved their goal of 100

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191 they reported, they achieved their goal of 100 percent accuracy in scheduling patients with the patients’ primary care providers and verifying insurance in advance of patient appointments. At the start of the RIE, none of these activities was being monitored, so there is no baseline with which to compare the outcomes. However, the rates did progress throughout the project. At 30 days, 75 percent of patients were being seen by their primary care doctors. At 60 days, 95 percent of patients were being seen by their primary care doctors after the metric was altered to exclude walk-ins. At 90 days, 100 percent of patients were being seen by their assigned physicians. Other reported outcomes mentioned by at least one interviewee, including the process owner/assistant director, consultant/physician manager, executive sponsor/administrative director, or another executive, include: Fostered a stronger sense of teamwork and connection to others across nursing, physician, and administrative roles. Changed patient workflow and scheduling, which ensures that the daily clinics start and end on time. Eliminated staffing with a separate doctor just to see walk-ins. Decreased denials of payment by an estimated 70 percent. Further, one manager observed that staff absenteeism rates and promptness had improved as the result of an increased sense of camaraderie among the team, but no factual evidence was provided. The amount of efficiency that could be gained from this RIE was limited, according to two department directors. As the result of process changes, staff took on increased duties and responsibilities that require more documentation and checkpoints per patient. These changes mean that staff are spending more time checking insurance cards and patient insurance-related data on the computer rather than engaging with the patient. This additional work was offset by fewer denied claims requiring followup by the billing department. A few senior leaders and executives reported that the Pediatric Continuity of Care project was less successful than others in the ambulatory care value stream because Lean principles have not spread as far as in, for example, the emergency room where multiple projects were undertaken. The Continuity of Care project was the only Lean project conducted in pediatric ambulatory care. Outcomes of Lean In this section, we discuss the outcomes of Lean for the organization as a whole, based on the projects included in the case study, as well as other information about Lean implementation provided by interviewees. Outcomes are classified as intermediate or ultimate outcomes, according to the conceptual framework. As described previously, intermediate outcomes are culture change, employee satisfaction, change in Lean knowledge and skills, and Lean routinization. Ultimate outcomes are impacts on efficiency, patient satisfaction and experience, clinical process and outcomes assessments, and patient safety. For organizations to sustain Lean,
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