Reducing Client Cycle Times for Clinical Visits


Impact Statement: 
Client complaints and staff dissatisfaction with prenatal clinic wait times led the Seminole County DOH to use QI to decrease their client visit times. Focusing on modifying the prenatal scheduling matrix, eliminating duplicate charts, and decreasing the physical distance traveled between check-in and the clinic helped the team decrease wait times by 21%.

Using the Lean Six Sigma Define, Measure, Analyze, Improve, Control (DMAIC) approach to quality improvement (QI), the Florida Department of Health in Seminole County decreased the average client cycle time for short clinical visits by 48%. On the basis of client complaints and staff dissatisfaction with shifts ending after business hours, the executive leadership requested that the quality council examine the clinical service process flow. After evaluating several clinical process components, the quality council selected client cycle time for an agency and Lean Six Sigma Green Belt certification improvement project. The multidepartmental team used client router forms to document wait and process times for clients seen for clinical services between September and October 2014 and determined the average cycle time to be 67 minutes. A benchmark of 45 minutes was obtained from state QI data.

A careful analysis of the stratified data was used to identify potential root causes and to statistically verify three contributing causes to increased client wait and processing times. These causes included duplication of charting, inadequate assigned appointment length, and the physical distance and separation of the check-in area from the clinic. The team then determined the most feasible countermeasures and implemented an action plan consisting of educating employees, eliminating redundancies, consolidating registration practices, and modifying the appointment scheduling matrix over a 3-week pilot period. Patient routers were again used to collect client cycle time data. Results showed an average cycle time of 47 minutes for short visits, a 21% decrease since implementing the countermeasures.            

Organization that conducted the QI initiative: 
Florida Department of Health in Seminole County

Warren, S. Public Health Quality Improvement Exchange. Reducing Client Cycle Times for Clinical Visits. Tue, 05/05/2015 - 09:35. Available at Accessed June 22, 2024.

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