Date of Award

Winter 2017

Document type


Degree Name

Masters theses/dissertations - taught courses

First Supervisor

Dr. Pauline Joyce


Waiting Times, Outpatients, Patient Flow


This consultant-led outpatient breast clinic in a large teaching hospital in Dublin often experiences clinic delays due to slow patient flow through the clinic processes. Patients have expressed dissatisfaction with the long queuing times and staff believe that patient flow can be improved with enhanced communication. The aim of this Quality Improvement Project is to examine the clinic process in detail using Lean and Six Sigma tools within a DMAIC framework to discover the priority delay points and recommend measures to improve patient flow. The choice of tools used was guided by a comprehensive literature review. Value Stream Mapping techniques are applied and a basic queuing simulation Gantt chart model is created to demonstrate that the proposed new consultation rates and staff availability changes can reduce patient clinic waiting times. Under the recommendations, no staffing, major process changes or extra funding is required to reduce queuing bottlenecks in the clinic, only the introduction of a patient flow co-ordinator role for a current staff member. The expected outcomes after implementation are an average reduction of waiting time to first clinician consultation for non-Triple Assessment patients of 28% and for Triple Assessment patients a 56% reduction, with clinics finishing 15 minutes earlier. Additionally, this project plan’s recommendations of improved clinic communication tools, patient flow control measures, monitoring, training and feedback proposals, should create a culture of continuous quality improvement and increase patient and staff satisfaction.

Creative Commons License

Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-Share Alike 4.0 License.

File Size

1.6 MB


A Dissertation submitted in part fulfilment of the degree of MSc in Physician Associate Studies, Royal College of Surgeons in Ireland 2017.