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Success Story: A Simple Worksheet Helps a Urology Clinic Be “Lean”

Learn how a urology clinic collects ideas for process improvement initiatives with a simple worksheet, then carries out these ideas using Lean principles.

What Was the Problem?

The Urology Clinic at Taubman Center at the University of Michigan Health System has been using Lean methods in daily work for over 3 years in clinics and call centers. Interdisciplinary teams at all levels of the organization are invested in this approach. Teams huddle daily with their managers to call attention to problems, then find ways to solve them. The medical director's standard work includes weekly leadership walks to engage with team members and support their progress. Although Lean methods had been successfully implemented, the group needed a straightforward and simple method to advance their process improvement ideas.

Developing the Intervention

Clinical and clerical team members actively engage in a culture of continuous improvement with Everyday Lean Idea (ELI) worksheets to propose process improvement ideas.

Using ELIs shifts the manager's role from primary problem-solver to a coach who helps team members solve problems. The ELI system works because of the assumption that the team members who actually do the work are in the best position to improve processes. With ELI, front-line team members identify problems and waste, investigate root causes, and propose solutions to test.

The ELI worksheet is quick and easy to submit. Department managers are committed to giving rapid feedback on proposed ideas. Many suggestions are endorsed on the spot as “Just Do It,” while others may need manager involvement or Lean intervention to resolve and implement a solution.

Electronic tools are used to document and track the ELIs. This allows the information and learning points to be easily shared within the Urology Clinic as well with the wider University of Michigan Health System.

Examples of ELIs that have been implemented include:

  • Placing a list of physicians' glove sizes in each procedure room, enabling the medical assistant to set up the room with the correct gloves for the specific physician each day.

  • Creating a “concierge card” that travels with the patient during their visit. This card informs the physician and care team members if anyone (eg, family member, friend, neighbor) has accompanied the patient to the visit. After the visit, the card serves as a reference for the patient by listing the name and role of everyone from the practice team who participated in his/her care that day.

  • Posting signage on restroom doors near the entrance to the multispecialty facility to alert urology patients to report directly to check-in before using the restroom. This makes it easier to collect urine samples needed for a visit.


Many of the ELI suggestions were simple to implement at a low cost. While some of the ELIs may seem minor, collectively, they have greatly improved the effectiveness and efficiency of the clinic's operations.

About the Organization

The Urology Clinic at Taubman Center is part of Michigan Medicine in Ann Arbor. Michigan Medicine is one of the largest hospitals in Michigan and a premier academic medical center affiliated with the University of Michigan. The A. Alfred Taubman Health Care Center is attached to University Hospital and houses state-of-the-art specialty clinics and outpatient services.

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