Improving patient flow at an outpatient clinic: study of sources of variability and improvement factors.

This paper focuses on analyzing and improving patient flow at an outpatient clinic of the Indiana University Medical Group. A structured process analysis and improvement approach was used to identify sources of variability and improvement factors. A process map, that matched the flow process at the clinic, was developed and validated. Key sources of variability that had potential to contribute to congestion in flow were identified. Data on task times were collected by observing the process with stopwatch or from historical records. A simulation model corresponding to the process map was developed, and the output was validated. Several ideas to modify clinic operations were tested on the validated simulation model. The overall result was an improvement in both the mean and the standard deviation of patient wait time, as well as higher utilization of physicians' time. The clinic has implemented several of our recommendations and experienced significant improvements.