Using lean techniques and discrete-event simulation for performance improvement in an outpatient clinic

Kudret Demirli, Abdulqader Al Kaf, Mecit Can Emre Simsekler, Raja Jayaraman, Mumtaz Jamshed Khan, E. Murat Tuzcu

    Research output: Contribution to journalArticlepeer-review

    9 Scopus citations


    Purpose: Increased demand and the pressure to reduce health-care costs have led to longer waiting time for patients to make appointments and during the day of hospital visits. The purpose of this study is to identify opportunities to reduce waiting time using lean techniques and discrete-event simulation (DES). Design/methodology/approach: A five-step procedure is proposed to facilitate the effective utilization of lean and DES to improve the performance of the Otolaryngology Head and Neck Surgery Outpatient Clinic at Cleveland Clinic Abu Dhabi. While lean techniques were applied to reduce the potential sources of waste by aligning processes, a DES model was developed to validate the proposed solutions and plan patient arrivals under dynamic conditions and different scenarios. Findings: Aligning processes resulted in an efficient patient flow reducing both waiting times. DES played a complementary role in verifying lean solutions under dynamic conditions, helping to plan the patient arrivals and striking a balance between the waiting times. The proposed solutions offered flexibility to improve the clinic capacity from the current 176 patients up to 479 (without violating the 30 min waiting time policy) or to reduce the patient waiting time during the visit from the current 33 min to 4.5 min (without violating the capacity goal of 333 patients). Research limitations/implications: Proposing and validating lean solutions require reliable data to be collected from the clinic and such a process could be laborious as data collection require patient and resource tracing without interfering with the regular functions of the clinic. Practical implications: The work enables health-care managers to conveniently conduct a trade-off analysis and choose a suitable inter-arrival time – for every physician – that would satisfy their objectives between resource utilization (clinic capacity) and average patient waiting time. Social implications: Successful implementation of lean requires a supportive and cooperative culture from all stakeholders involved. Originality/value: This study presents an original and detailed application of lean techniques with DES to reduce patient waiting times. The adopted approach in this study could be generalized to other health-care settings with similar objectives.

    Original languageBritish English
    Pages (from-to)1260-1288
    Number of pages29
    JournalInternational Journal of Lean Six Sigma
    Issue number6
    StatePublished - 19 Nov 2021


    • Discrete-event simulation
    • Lean health care
    • Outpatient clinics
    • Patient waiting time
    • Resource utilization


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