ABSTRACT
Ambulatory medical care is the most widely utilized part of the American healthcare system. Physician ofŽces comprised about four-Žfths of all ambulatory medical care delivered in 2006.* Between 1996 and 2006, visit rates to medical specialty ofŽces climbed by 29%; about 18.3% of all ambulatory care visits in 2006 were for non-illness or non-injury conditions, such as routine check-ups and pregnancy examinations. Because the ambulatory care setting plays a signiŽcant role in the healthcare delivery system, it is important to understand how Lean concepts and tools can be used to deliver highquality, cost-effective care.†
Primary care clinics are one of the most important assets and often the Žrst point of entry into the healthcare system. In many cases, unless a patient has open access, the primary care physician is the gatekeeper to accessing the next level of specialty care. Physician practice arrangements have become increasingly complex. They range from solo practitioners to large clinics that may provide primary care and sub-specialties. They may be owned and managed by the physician(s), a joint venture between a healthcare entity and physicians, or fully owned by a hospital system. The physician relation of employment varies as well, as they can be full or “partner” owners or “employees” of the physician-owned practice, clinic, healthcare entity, or hospital.
