From Clinic Bottlenecks to Breakthroughs: Using Lean to Improve Patient Access, Care, and the Bottom Line

With over 15 years of experience in critical care and clinic leadership, Daniel Mather, Director of Clinic Operations at Salina Regional Health Center, specializes in driving operational improvements, patient access and team development. He holds a Master’s in Executive Healthcare Leadership from Ottawa University.

In many healthcare settings, operational efforts often center on the back end of care, especially revenue cycle management, to strengthen the bottom line. While these processes are undeniably important, I’ve found that targeting the front end of care, particularly patient access, can yield equally powerful and often faster results.

The Power of the Gemba Walk

A Gemba Walk is a Lean management practice in which leaders go to the actual place (“Gemba” is Japanese for “the real place”) where work happens to observe processes, engage with staff, and identify improvement opportunities. I take this concept one step further by going straight to the patients.

When did you last spend 15–20 minutes walking through the intake process as a patient would? You might be surprised by what you find: unclear signage, redundant paperwork, vague appointment details. These seemingly small inefficiencies add up and directly impact patient satisfaction and clinic performance.

Improving Access = Improving Outcomes

By streamlining access in four key areas: pre-appointment communication, the appointment experience, scheduling and referrals, and ongoing patient communication, we increased both clinic and surgical volume by over 18 percent.

1.Pre-Appointment Communication

We began by reviewing the information patients received before their visits. Although our system sent automated appointment reminders, that was the extent of our outreach.

I asked a simple question: What else can our appointment software do that we’re not using?

We discovered that we were underutilizing several features. For instance, we enhanced our reminders with detailed maps showing where patients needed to go, a critical addition to our multi-building campus. We also adjusted the timing and frequency of reminders based on patient feedback.

The result: a significant drop in no-shows and late arrivals, and improved satisfaction

2. Onsite Navigation and Redundancy

Once patients arrived, we asked: Can they navigate easily? And how much redundancy can we remove?

We didn’t have access to high-end navigation apps, so we focused on what we could control: signage. With direct input from patients, we redesigned visual cues, including floor decals, to guide them clearly through our space.

We also reviewed the paperwork patients were asked to complete and eliminated unnecessary repetition.

The result: improved satisfaction and a noticeable drop in negative feedback related to wayfinding and check-in delays.

3. Scheduling and Referrals

Scheduling inefficiencies posed another major challenge. Reception staff had varying ideas about the length of appointments, leading to inconsistency and overbooking.

Using Lean process mapping, we identified breakdowns and created a standardized scheduling grid. This defined specific timeframes for each provider, appointment type, new patient, follow-up, pre-op, etc. We established clear SOPs and reserved same-day slots for high-priority groups like acute injuries, pediatric cases, and athletes. Provider requests to block schedules now require leadership approval. The result: fewer scheduling errors, better access for timesensitive patients, and a smoother workflow overall.

4. Patient Communication: Calls, Texting, and Portals

At one point, our clinic was receiving over 4,800 calls per month, resulting in 35–45 voicemails daily and delayed responses that frustrated patients and hurt our reputation.

We approached this from several angles:

• We revamped our auto attendant to route calls more effectively.

• Designated a daily phone nurse, rotating based on OR and clinic schedules.

• I activated two-way texting, a feature we already paid for but hadn’t implemented. Even older patients appreciated the clarity of having a text for reference, while younger patients loved the convenience.

• Promoted our patient portal, encouraging patients to message nurses and providers directly.

The outcome: daily voicemails dropped from 35+ to just 1–2. Reception staff gained time to complete same-day administrative tasks like FMLA and work comp paperwork, something patients sincerely appreciate. Check-in times improved, and satisfaction scores rose without adding FTEs or increasing costs.

Conclusion

Focusing on access before, during, and after appointments improved clinic operations, increased patient satisfaction, and increased clinic and surgical volume by over 18 percent. Staff appreciated the clarity, standardization, and reduced confusion. And none of it required extra FTEs, outsourcing, or significant investments.

We leveraged existing tools and applied Lean thinking to remove friction and improve flow.

When clinical care and operations align, everyone benefits—patients, staff, and the bottom line.