Improving efficiency in a residency training clinic: results from addressing a root cause of inefficiency.

BACKGROUND: Since the early 1980s, primary care teaching clinics have repeatedly been reported to be inefficient. This paper describes the results of a 5-year effort to improve the efficiency of our residency teaching clinic.
METHODS: This 5-year longitudinal tracking study of a clinic monitored monthly patient volume, number of providers scheduled per half day, and patient satisfaction with waiting times while interventions occurred to improve clinic efficiency.
RESULTS: Prior to rigorously tracking the number of providers in clinic, monthly clinic patient volume increased temporarily (1998-1999) but fell back to baseline the following year. Variation in the number of providers in clinic explained nearly half the variability in the number of patients seen. After beginning a process of tracking and proactively optimizing the number of providers in clinic per half day, patient volumes increased significantly and stabilized at the higher levels. Patient satisfaction with waiting time improved slightly.
CONCLUSIONS: Tracking and optimizing a single operational variable can improve clinic performance significantly. Reducing the variation in the number of providers scheduled to see patients toward an optimum number based on the number of available exam rooms resulted in sustainable increases in the number of patients seen without any negative impact on the patient satisfaction with waiting times.