The implication of the Lean Kanban Pull Methodology for Improving the attendance of diabetic clinic appointments, improving the quality of visits, reducing the overall waste of appointments, and further reducing the overwhelming of the appointment system, gives priority to those who need to be seen the earliest and improve overall diabetes control and patient experience.
Tool: Lean Kanban Pull Methodology
Problem: Booking in the Chronic Illness Clinic for Diabetic patients was based on the nearest available appointment for new patients. The follow-up patient was scheduled after 3-6 months, according to the hba1c control. The result was poor control of patients’ diabetes HbA1c>9 to 21%, bad patient experience and waste of resources.
Tool Selection: Lean methodology reduces resource waste and process/product flaws to improve performance. We used the Kanban Pull system to initiate the appointments monthly, depending on the estimated need, and allocate different appointment duration according to their latest hba1c. The appointments will be created according to the estimated total hours needed monthly.
Usage: Start using a new database registry for the CIC and change the appointment system, allowing us to allocate more visit time to uncontrolled patients (Hba1c>9) to 30 minutes, on the other hand, reducing the time allocated for well-controlled patients (hba1c<7) to be 10 minutes for each.
Results: Attendance at the CIC clinic improved from 68% to 85%. Appointment slots increased from 7% to 40% in May 2022. The overall uncontrolled Hba1c>9 percent has been reduced from 21% in January 2021 to 11.8% in September 2022
