Document Type


Degree Name



Dept. of Medical Informatics and Clinical Epidemiology


Oregon Health & Science University


OBJECTIVE: This paper will show how Lean quality improvement methods can be used in healthcare to improve pediatrician performance on a quality metric tracking development of plans for addressing obesity in children at well child checks. METHODS: Using Lean methods, the entire process for measuring the documentation of obesity treatment plans, from identification of obesity to the production of the metric, was mapped out. After waste in the process was identified, root cause analysis was performed. Countermeasures were then developed and tested to eliminate waste in the process, and a new process was created. This was used to create standard work documents for training and reference. RESULTS: After implementation of the new process, several areas of waste were identified and corrected and performance on the metric improved greatly. Key problems with the initial process identified and corrected included failure to document body mass index, failure to obtain indicated diet history, failure to address obesity, and documentation of the treatment plan in a way that was not measured by the quality metric reporting process. Once the new process was in place, the pediatrician involved in the Lean event saw his performance on the metric improve from 26% of obese children having a treatment plan prior to the event, to 100% for the two months following the event. In addition, both medical assistants and physicians showed an increased understanding of how the metric was measured and their role in the process after the project was completed. CONCLUSION: Lean quality improvement methods can be used in healthcare to improve performance on quality metrics. Problems with both staff performance and performance of information technology systems including electronic health records can be identified and corrected. Continued monitoring is required to ensure that improvements resulting from the Lean improvement event are sustained.




School of Medicine

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