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Journal of the Dermatology Nurses' Association

April 2012, Volume 4 Number 2 , p 136 - 142


  • Jerry Rice
  • Kathleen Haycraft


How do you develop an office practice that is patient focused, effective, and efficient? The Institute of Medicine has released two sentinel reports on healthcare errors and promotion of quality (Institute of Medicine, 2001; Kohn, Corrigan, & Donaldson, 2000). These reports address the need to create efficient medical practices while reducing error rates (Carey & Lloyd, 2001). Lean and Six Sigma are tools that will contribute to these goals.Office practices are busy and sometimes chaotic with many patients and procedures flowing through in a day. A patient may be in the office anxiously awaiting biopsy results while the clerk sorts through reports, only to find that the biopsy has not been reported yet. The medical assistant might be requesting the same information from the patient that the receptionist just requested. The nurse just finished labeling three biopsy specimens for one patient as she is worrying about being 30 minutes behind. In the midst of clinical care, the coding clerk may be questioning if the ICD-9 code assigned to the bill supports the CPT code. The opportunities for errors abound.Lean and Six Sigma are well established in many businesses today. What are they and how do they apply to a dermatology practice? Lean and Six Sigma are simply tool sets that allow organizational improvement strategies to be realized. They are not strategies in and of themselves. A clinic must still have a clear vision of where it wants to go; Lean and Six Sigma methods will help it get there.Clinic leadership must be involved to provide vision, basic knowledge, resources, and support necessary to fully realize the benefits of these tools. The Lean and Six Sigma tool sets, when used appropriately, will allow a practice to take advantage of continuous improvement opportunities. These tools, along with others like human resource development methods, will set any practice on the path to organizational excellence.The Lean strategy focuses on the elimination of operations that

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