Integrating patient education into the glaucoma clinical encounter: A lean analysis

Paula A. Newman-Casey, John A. Musser, Leslie M. Niziol, Michele M. Heisler, Shivani S. Kamat, Manjool M. Shah, Nish Patel, Amy M. Cohn

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


Purpose:The main purpose of this study was to use Lean analysis to identify how often and when wait times occur during a glaucoma visit to identify opportunities for additional patient engagement.Methods:This prospective observational time-motion study measured process and wait times for 77 patient visits from 12 ophthalmologists at an academic glaucoma clinic over a 3-month period. Value stream maps visually diagramed the process of a clinical visit from the patient's perspective. Descriptive statistics were calculated for process times, wait times, and the frequency of 10+ minute wait times during each part of the visit. Key stakeholders participated in a root cause analysis to identify reasons for long wait times. The main outcome measure was average times (hours: Minutes: Seconds) for process times and wait times.Results:Twenty-nine new visit (NV) patients and 48 return visit (RV) patients were included. Total time in clinic was 187.1±44.5 (mean±SD) minutes for NV patients and 102.0±44.7 minutes for RV patients. Wait time for NV patients was 63.7±33.4 minutes (33.1% of total appointment time) and for RV patients was 52.6±31.6 minutes (49.4% of the total appointment time). All NV patients and 87.5% of RV patients had at least one 10+ minute wait time during their clinic visit and the majority (75.9% NV, 60.4% RV) had >1.Conclusions:Currently, sufficient wait time exists during the visit for key portions of glaucoma education such as teaching eye drop instillation.

Original languageEnglish (US)
Pages (from-to)415-422
Number of pages8
JournalJournal of Glaucoma
Issue number5
StatePublished - May 1 2019
Externally publishedYes


  • Lean analysis
  • education
  • glaucoma
  • operations engineering

ASJC Scopus subject areas

  • Ophthalmology


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