Date of Publication


Project Team

Margaret Aitken


The purpose of this project was to assess the current workflow for addressing the needs of patients between face-to-face healthcare visits at a primary care clinic in Northern New England. The assessment served as a framework to inform recommendations for process improvement interventions. Workflow was mapped using Lean’s value stream map (VSM) tool. Observational data and retrospective chart review were performed to collect information on time to complete tasks, equipment used, and personnel involved in each patient request. Key patterns in workflow variation, guided by theoretical frameworks of system constraints, were identified. Finally, a team brainstorming session was organized with practice staff to engage stakeholders and generate actionable next steps for process improvement. Process mapping was especially useful as a visualization tool to engage stakeholders and isolate reasons for variation. There were four maps created to assess the workflow to respond to patient requests. The brainstorming session with staff concluded with two major areas of process improvement and next steps. Interventions would focus on maximizing use of health information technology and adjusting protocols for referrals sent to specialists with long scheduling periods. This approach can be used to systematically assess workflow practice of the primary care team. Results indicate that using the mapping tool in tandem with healthcare-specific assessment tools and theoretical frameworks helps identify opportunities for process improvement in the primary care office.

Document Type


Included in

Nursing Commons