PHS81 - Lean Workflow changes may contribute to Improved primary care patient satisfaction

Abstract

We examined the impact of Lean workflow changes on primary care patient satisfaction across 17 primary care locations in a large, multispecialty health care provider in Northern California. The health care provider serves more than two-million patients across four California counties. It adopted Lean practices in an attempt to transform its primary care delivery. Patient satisfaction (Press-Ganey (PG) outpatient survey) and administrative data were used for this study. The PG survey covers several topics of the patient experience including Patient Access, Moving through the Visit, Care Provider, Nurse/Medical Assistant, and Handling of Personal Issues. A composite satisfaction score across these topics was used in primary analyses. Longitudinal data from 2010 to 2014 was used and includes data before and after the Lean implementation. Segmented regression analysis of interrupted time series was used to analyze physician-level PG scores over time, adjusting for physicians scheduled hours and seasonality. Across the organization, the composite patient satisfaction was decreasing (0.2%, p<0.001) per month prior to Lean implementation. This trend was reversed, with a statistically significant increase (0.2%, p=0.02) observed during the post-Lean period. Interestingly, the pre-Lean trend for patient access domain were decreasing at 0.3% per month (p<0.001) while a significant positive trend (0.8%, p<0.001) was observed during post-Lean period. Across all providers, an 8.3% increase (95% CI: [7.7%, 8.8%]) was projected in satisfaction scores with Lean implementation versus what would have happened if Lean was not implemented. The patient access domain was projected with an 11.5% (95% CI: [10.2%, 12.9%]) increase across all providers. We observed varying levels of improvement in composite patient satisfaction and its domains. There was a significant increase in satisfaction trends following the implementation of Lean. Primarily, the patient access domain appeared to drive the improved overall patient satisfaction.