Lean service operations: Reflections and new directions for capacity expansion in outpatient clinics

This field research in outpatient service operations examines original quantitative data on appointments and analyzes a lean process improvement project that was conducted to increase capacity to admit new patients into a healthcare service operation system. Analysis of 1726 intake appointments for the year preceding and the full year following the lean project showed a 27% increase in service capacity to intake new patients and a 12% reduction in the no-show rate as a result of the transformation of service processes achieved by the lean project. This study's action research methodology leverages the researcher's involvement in redesigning a service system that greatly improved performance and led to reflection on traditional operations management (OM) approaches to appointment scheduling. The study generates insights about effective alignment of resources, develops new strategies for service operations to respond to no-shows, reveals time-related variables that have been overlooked in appointment scheduling research, and challenges traditional OM scheduling performance measures. We provide recommendations for effective and appropriate use of overbooking and identify avenues for future research to continuously improve and increase the capacity of service operations. (C) 2010 Elsevier B.V. All rights reserved.