Lean Six Sigma Methodology in the Implementation of a Standardized Health Literacy Assessment in a Safety Net Internal Medicine Residency Clinic

BACKGROUND: Lean Six Sigma is a set of techniques intended to improve processes by greatly reducing the probability that errors will occur. The Lean Six Sigma approach was used to engage staff and clinicians in standardizing the assessment of patient health literacy in an academic safety net clinic. BRIEF DESCRIPTION OF ACTIVITY: Clinicians were surveyed, and a chart review was conducted to attain baseline information regarding the uniformity of health literacy assessment and documentation in the clinic. A workgroup used the survey data and Lean Six Sigma quality improvement tools to determine the root cause, which was the lack of standardization. IMPLEMENTATION: To address this root cause, a standardized process for health literacy assessment in the clinic was developed; an assessment tool was selected, support staff were trained, and the new process was initiated. A support staff focus group was conducted, and a second clinician survey was disseminated to gauge perception of the new health literacy assessment and documentation processes. Quantitative data were collected to assess the coverage achieved by the new processes. Monthly reporting and staff feedback sessions were conducted to ensure continued efficacy of the protocol. RESULTS: Standardized assessment and documentation processes were effectively implemented using the Lean Six Sigma approach in an academic safety net clinic. Providers and rooming staff were satisfied with the new processes. Rooming staff input and buy-in were critical to successful implementation. LESSONS LEARNED: Our findings suggest that Lean Six Sigma tools and methodologies can be appropriate for health care quality improvement and process standardization in an academic safety net clinical setting. [HLRP: Health Literacy Research and Practice. 2019;3(1):e25–e30.] PLAIN LANGUAGE SUMMARY: A growing body of evidence supports the role of Lean Six Sigma (LSS) tools and processes for the assessment, design, and implementation of the quality improvement in the health care industry. This study explored the use of LSS on the standardization and documentation of health literacy assessment of patients in an academic safety net clinic. Findings suggest that LSS is an appropriate method of standardizing assessment and documentation of health literacy in this clinical setting.