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Asia Pac J Oncol Nurs. 2019 Oct-Dec;6(4):381-388. doi: 10.4103/apjon.apjon_21_19.

Improving the Workflow Efficiency of An Outpatient Pain Clinic at A Specialized Oncology Center by Implementing Lean Principles.

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King Hussein Cancer Center, Amman, Jordan.



Adult outpatient oncology pain clinics face many challenges due to the increased number of patients, the restriction of electronic appointment systems, overcrowding, waiting time, and patient dissatisfaction. This project aimed to improve clinic time efficiency, decrease clinic waiting time, and improve patient satisfaction.


Lean thinking concepts and their tools, for example, value-stream mapping and value added (VA)/non-VA (NVA) analysis were used. Electronic appointment system slots were stratified based on patient visit type. A total of 187 patients were included in a time-motion survey at three different occasions: preintervention (n = 67) and two consecutive quarter postintervention time points (n = 64, n = 56). Simultaneously, patient satisfaction was reported quarterly by a quality management office.


The pain clinic workflow became more efficient; the mean clinic waiting time decreased from 72.5 min at preintervention to 19.5 and 21 min at the two postintervention quarters, respectively. Moreover, patient satisfaction improved from 75% at the preintervention to 100% and 96.7% at the two postintervention quarters.


Redesigning the process of an electronic appointment system using lean thinking considerably decreases patients' waiting time, improves patient satisfaction, improves resource utilization, allows proper scheduling based on patient visit types, eliminates unnecessary waste processes, and reallocates health-care providers' time toward direct, individualized patient care.


Lean principle; pain clinic; patient satisfaction; quality; waiting time; workflow

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