​​​​Carlo Ordonez, Zelia Raposo, and Neuville Wao
(L to R) Carlo Ordonez, Clerk; Zelia Raposo, Clerk; and Neuville Wao, Orthopaedic Technician review the schedule of appointments for the Fracture Clinic. (Photo: UHN)​

When Lean was introduced, the Toronto Western Fracture Clinic was the second most complained about clinic at UHN.

There are approximately 26,000 patient visits at the post-operative clinic and most visits averaged three to four and a half hours in length.

"Many of our patients come to us with chronic pain and mobility issues and need our services for weeks, months and sometimes years," said Mary-Ann Dow, Manager, Fracture Clinic. "It makes for an extremely busy and sometimes chaotic environment."

'Wouldn't have happened without Lean'

The Musculoskeletal-Orthopaedic clinic team mapped out the patient's journey and decided the Fracture Clinic would benefit from the support of Lean methodology.

In fall 2013, the clinic hosted a Rapid Improvement Event (RIE) to address patient flow concerns and improve the patient experience.

The whole team was involved in the RIE, including support services like Housekeeping.

"The RIE made us realize we didn't communicate well with each other in the clinic," said Dow. "It gave us an opportunity to improve everyone's understanding of each other's roles and responsibilities. This wouldn't have happened without Lean."

Analyzing the patient experience

The RIE focused on educating staff on the whole patient experience and the different steps that take place during a visit: registration, x-ray, assessment, physician consult and cast application or removal.

"The RIE process was painful at first," said Dow. "Then, light bulbs went off and we started to appreciate how this could help us make improvements to our processes."

One key learning from the RIE is how long it takes for each type of x-ray. Now, the staff who are responsible for appointment booking allot the correct amount of time for each patient. This has cut down on the length of waiting time during the appointment – patients now spend 1.5 to 2 hours in the clinic (the aim is 110 minutes) and the clinic has maintained the same number of patient visits.

 "We are getting less complaints and more positive comments," said Dow. "Patients are also better at arriving on time for their appointments because they know they won't be stuck waiting hours like they previously did."

The staff continue to huddle every day and find opportunities to further improve the patient experience.

WATCH: To learn more about how Lean is making change at UHN, watch this video.

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