College complaints against resident physicians in Canada: a retrospective analysis of Canadian Medical Protective Association data from 2013 to 2017.

BACKGROUND: An understanding of regulatory complaints against resident physicians is important for practice improvement. We describe regulatory college complaints against resident physicians using data from the Canadian Medical Protective Association (CMPA). METHODS: We conducted a retrospective analysis of college complaint cases involving resident doctors closed by the CMPA, a mutual medicolegal defence organization for more than 100 000 physicians, representing an estimated 95% of Canadian physicians. Eligible cases were those closed between 2008 and 2017 (for time trends) or between 2013 and 2017 (for descriptive analyses). To explore the characteristics of college cases, we extracted the reason for complaint, the case outcome, whether the complaint involved a procedure, and whether the complaint stemmed from a single episode or multiple episodes of care. We also conducted a 10-year trend analysis of cases closed from 2008 to 2017, comparing cases involving resident doctors with cases involving only nonresident physicians. RESULTS: Our analysis included 142 cases that involved 145 patients. Over the 10-year period, college complaints involving residents increased significantly (p = 0.003) from 5.4 per 1000 residents in 2008 to 7.9 per 1000 in 2017. While college complaints increased for both resident and nonresident physicians over the study period, the increase in complaints involving residents was significantly lower than the increase across all nonresident CMPA members (p < 0.001). For cases from the descriptive analysis (2013-2017), the top complaint was deficient patient assessment (69/142, 48.6%). Some patients (22/145, 15.2%) experienced severe outcomes. Most cases (135/142, 97.9%) did not result in severe physician sanctions. Our classification of complaints found 106 of 163 (65.0%) involved clinical problems, 95 of 163 (58.3%) relationship problems (e.g., communication) and 67 of 163 (41.1%) professionalism problems. In college decisions, 36 of 163 (22.1%) had a classification of clinical problem, 66 of 163 (40.5%) a patient-physician relationship problem and 63 of 163 (38.7%) a professionalism problem. In 63 of 163 (38.7%) college decisions, the college had no criticism. INTERPRETATION: Problems with communication and professionalism feature prominently in resident college complaints, and we note the potential for mismatch between patient and health care provider perceptions of care. These results may direct medical education to areas of potential practice improvement.

The recognition and expectations of ex-inpatients of mental health services: A web-based questionnaire survey in Japan.

Concern about mental health issues and the treatment of mentally disordered offenders attracts considerable public attention. This study aimed to gather the experiences and opinions of people who have experienced admission to a psychiatric ward in order to grasp their reaction to, and understanding of, the legislation behind the involuntary admission of psychiatric patients. A web-based questionnaire survey was conducted with a total of 379 participants, using a cross-sectional, exploratory design. The data were analyzed using a chi-squared test, Fisher's exact test, and a logistic regression analysis. According to the results, many patients were satisfied with their treatment during psychiatric admission; however, only few participants said that they had been given an adequate explanation for their involuntary treatment. Most participants expected qualified assistance after discharge, although the prospect of a regular visit from an official was not entirely supported by the participants. Patient satisfaction was relevant to the discussion of their needs after discharge and in developing a crisis plan during admission. These findings suggest that psychiatric patients accept inpatient treatment as long as they receive an adequate explanation. More qualified care such as relapse prevention would be expected to lead to better satisfaction. For them to welcome regular visits from an official, patients may need more information and discussion.

Why Do Medical Professional Regulators Dismiss Most Complaints From Members of the Public? Regulatory Illiteracy, Epistemic Injustice, and Symbolic Power.

Drawing on an analysis of complaint files that we conducted for the Irish Medical Council (Madden and O'Donovan 2015), this paper offers three possible explanations for the gap between the ubiquity of official commitments to taking patients' complaints seriously and medical professional regulators' dismissal-as not warranting an inquiry-of the vast majority of complaints submitted by members of the public. One explanation points to the "regulatory illiteracy" of many complainants, where the remit and threshold of seriousness of regulators is poorly understood by the general public. Another points to possible processes of "institutional epistemic injustice" (Fricker 2007; Anderson 2012) that unjustly undermine the credibility of certain complainants, such as those with low levels of formal education. A third explanation highlights the marginalization of the general public from "symbolic power" (Bourdieu 1989) to define what matters in medical professional regulation. The paper is offered in a spirit of ideas in progress and raising questions rather than definitive insights into the regulatory process.

Measuring Patient and Staff Satisfaction Before and After Implementation of a Paperless Registration System.

EXECUTIVE SUMMARY: While many aspects of patient care have transitioned to digital technology, the patient registration process often is still paper based. Several studies have examined the effects of changes in clinic workflows and appointment scheduling on patient satisfaction, but few have investigated changes from a paper-based to a paperless registration process. The authors measured patient and staff satisfaction before and after implementation of a new, tablet-based registration process at NYU Langone Health's Center for Women's Health in New York City. Mean preimplementation patient satisfaction scores on the six questions related to the registration process (1-5 scale, with 5 being the highest score) ranged from 4.0 to 4.5. Postimplementation satisfaction scores on the nine questions (six premeasure questions and three additional questions related to the tablet-based process) ranged from 4.4 to 4.6, with four of the six premeasures showing statistically significant improvement in patient satisfaction. Staff satisfaction was generally lower (2.8-3.6 preimplementation and 2.8-4 postimplementation), with no statistically significant difference between time frames. Patient satisfaction was relatively high under the paper registration process, and it improved significantly in some respects under the paperless process, while staff satisfaction did not change. The convenience and ease of use of a paperless registration system can help maintain or increase patient and staff satisfaction while introducing new workflows and improving the efficiency of the outpatient registration process. In adopting technology that can lead to changing workflows, organizations should train staff members and support them during the process.

THE VICTORIAN NEW HEALTH COMPLAINTS ACT 2016 -- WHAT ARE THE CHANGES?

The Health Complaints Act 2016 (Vic) commenced on 1 February 2017, bringing into operation a new office of the Health Complaints Commissioner (HCC). This article outlines the changes nurses and midwives are likely to see under the new Act.

Listening to Improve: Transforming Patient Relations Measurement and Reporting in Ontario.

Effective patient relations are important to improve patient experience and deliver better care. Policy and legislative changes in Ontario have increased accountabilities for patient relations and expanded Health Quality Ontario (HQO)'s mandate. In response, HQO collaborated with patients, health sector organizations, associations and the Ministry of Health and Long-Term Care to co-design a patient relations measurement and reporting approach. Informed by an environmental scan, broad consultations, a multi-sector survey and a provincial advisory group, the approach includes standardized patient relations indicators to support measurement and public reporting across the hospital, home and long-term care sectors. Pilot testing with 29 sites across three sectors will inform province-wide implementation.

[Hearing Aid Fitting in Adults]. / Hörgeräteversorgung für Erwachsene.

The identification and treatment of hearing disorders belong to the fundamental tasks of an ENT-specialist. In this context the fitting of hearing aids has a special relevance. To verify a highly qualified medical care the knowledge of the audiological threshold values for the indication of the fitting of hearing aids and the detection of early signs for impaired communication are essential. The current quality assurance agreement defines technical and steric conditions pertaining to hearing aid fitting in the context of statutory health insurance. Only after approval of these postulated requirements the attending physician is allowed to bring to account his effort. The current regulations on medical devices specify both the basic requirement for a medical prescription and the expenses for hearing aids that are covered by the healthy insurances. A qualified hearing aid fitting is only possible if the ENT-specialist not only prescribes the device, but also conscientiously checks the comparative adjustments made by the hearing aid acoustician. Beside the knowledge about the general mode of operation and the different types of hearing aids ENT-specialist should know audiological and anatomic limits for the fitting of hearing aids.

Strategies for Acing the Fundamentals and Mitigating Legal and Ethical Consequences of Poor Physician-Patient Communication.

This article explores how the absence of effective verbal and nonverbal communication in the physician-patient encounter can lead to poor outcomes for patients and physicians alike. The article discusses legal and ethical topics physicians should consider during a medical encounter and provides educational and practical suggestions for improving effective communication between physicians and their patients.

Analysis of Factors Associated With Rhytidectomy Malpractice Litigation Cases.

IMPORTANCE: This study investigates the financial burden of medical malpractice litigation associated with rhytidectomies, as well as factors that contribute to litigation and poor defendant outcomes, which can help guide physician practices. OBJECTIVE: To comprehensively evaluate rhytidectomy malpractice litigation. DATA SOURCES AND STUDY SELECTION: Jury verdict and settlement reports related to rhytidectomy malpractice litigations were obtained using the Westlaw Next database. Use of medical malpractice in conjunction with several terms for rhytidectomy, to account for the various procedure names associated with the procedure, yielded 155 court cases. Duplicate and nonrelevant cases were removed, and 89 cases were included in the analysis and reviewed for outcomes, defendant specialty, payments, and other allegations raised in proceedings. Data were collected from November 21, 2015, to December 25, 2015. Data analysis took place from December 25, 2015, to January 20, 2016. RESULTS: A total of 89 cases met our inclusion criteria. Most plaintiffs were female (81 of 88 with known sex [92%]), and patient age ranged from 40 to 76 years (median age, 56 years). Fifty-three (60%) were resolved in the defendant's favor, while the remaining 36 cases (40%) were resolved with either a settlement or a plaintiff verdict payment. The mean payment was $1.4 million. A greater proportion of cases involving plastic surgeon defendants were resolved with payment compared with cases involving defendants with ear, nose, and throat specialty (15 [36%] vs 4 [24%]). The most common allegations raised in litigation were intraoperative negligence (61 [69%]), poor cosmesis or disfigurement (57 [64%]), inadequate informed consent (30 [34%]), additional procedures required (14 [16%]), postoperative negligence (12 [14%]), and facial nerve injury (10 [11%]). Six cases (7%) involved alleged negligence surrounding a "lifestyle-lift" procedure, which tightens or oversews the superficial muscular aponeurosis system layer. CONCLUSIONS AND RELEVANCE: In this study, although most cases of rhytidectomy malpractice litigation were resolved in the defendant's favor, cases resulting in payments created substantial financial burden for the defendants. Common factors cited by plaintiffs for pursuing litigation included dissatisfaction with cosmetic outcomes and perceived deficits in informed consent. These factors reinforce the importance of a comprehensive, preoperative informed consent process in which the specific potential risks and outcomes are presented by the surgeon to the patient to limit or avoid postsurgical allegations. Intraoperative negligence and facial nerve injury were significantly more likely to result in poor defendant outcomes. LEVEL OF EVIDENCE: NA.

Efectividad de un programa de alta precoz tras parto normal / Effectiveness of an early discharge program after normal childbirth

Objetivo. Implantar un programa de alta precoz hospitalaria en el parto sin complicaciones para mejorar la efectividad, garantizando la seguridad clínica y la aceptabilidad de los pacientes. Material y métodos. Estudio descriptivo de la efectividad de un programa de alta precoz en el parto sin complicaciones entre febrero de 2012 y septiembre de 2013. Población a estudio: puérperas y recién nacidos con ingreso en el Hospital Universitario de Fuenlabrada, con una duración inferior a 24h, tras parto sin complicaciones que cumplieran los criterios de inclusión definidos. La satisfacción se evaluó mediante una encuesta con escala Likert. La efectividad del programa se monitorizó mediante indicadores de seguridad, productividad, adecuación y continuidad asistencial. Resultados. El 20% de los casos susceptibles de alta precoz del Hospital Universitario de Fuenlabrada completaron el programa. El 94% fueron partos eutócicos. Los 188 casos incluidos —sobre 911 pacientes con parto no complicado— representaron el 6,5% del total de los 2.857 partos atendidos. La estancia media de las pacientes incluidas presentó una disminución del 50% (2,4 a 1,2 días). La continuidad asistencial tras el alta hospitalaria fue seguida por la totalidad de las pacientes. En el 4,8% se reprogramó una consulta de revisión. El 2% de las pacientes reingresaron antes de 96h por problemas no graves. Cuatro recién nacidos (2%) precisaron atención en urgencias (madre o recién nacido) antes de 96h. La evaluación de la satisfacción de las pacientes alcanzó 4,5 sobre 5. Conclusiones. El programa logró una disminución de la estancia media en un 50%, favoreciendo la autonomía de las matronas. Su nivel de aceptación está en línea con intervenciones similares. El despliegue realizado puede ser útil para otras modificaciones de procesos asistenciales (AU)

Objective. To implement a program of early hospital discharge after an uncomplicated birth, in order to improve the effectiveness, as well as ensuring clinical safety and patient acceptability. Material and methods. Descriptive study of the effectiveness of an early discharge program after uncomplicated delivery between February 2012 and September 2013. The populations are post-partum women and newborns admitted to the University Hospital of Fuenlabrada, with a duration of less than 24h after uncomplicated delivery that met the defined inclusion criteria. Satisfaction was assessed using a Likert scale. The effectiveness of the program was monitored by safety indicators, productivity, adaptation, and continuity of care. Results. A total of 20% of cases capable of early discharge from Fuenlabrada University Hospital completed the program. Almost all (94%) were normal deliveries. The 188 cases included were from 911 patients with uncomplicated childbirth, accounting for 6.5% of the 2,857 total births. The mean stay of patients included showed a decrease of 50% (2.4 to 1.2 days). All patients received continuity of care after hospital discharge. The review consultation was reprogrammed for 4.8% of cases, with 2% of patients re-admitted within 96h. with no serious problems. Four newborns (2%) required attention in the emergency department (mother or newborn) before 96h. The assessment of patient satisfaction achieved a score of 4.5 out of 5. Conclusions. The program achieved a decrease in the average stay by 50%, favouring the autonomy of midwives. This acceptance level is in line with similar interventions. The deployment of the program may be useful for other changes in care processes (AU)

Transparency of Mandatory Information Disclosure and Concerns of Health Services Providers and Consumers.

BACKGROUND: This study analyzed differences between transparency of information disclosure and related demands from the health service consumer's perspective. It also compared how health service providers and consumers are associated by different levels of mandatory information disclosure. METHODS: We obtained our research data using a questionnaire survey (health services providers, n = 201; health service consumers, n = 384). RESULTS: Health service consumers do not have major concerns regarding mandatory information disclosure. However, they are concerned about complaint channels and settlement results, results of patient satisfaction surveys, and disclosure of hospital financial statements (p < 0.001). We identified significant differences in health service providers' and consumers' awareness regarding the transparency of information disclosure (p < 0.001). CONCLUSIONS: It may not be possible for outsiders to properly interpret the information provided by hospitals. Thus, when a hospital discloses information, it is necessary for the government to consider the information's applicability. Toward improving medical expertise and information asymmetry, the government has to reduce the burden among health service consumers in dealing with this information, and it has to use the information effectively.

[Please do Something - no Matter what! A Nationwide Online Survey of Mental Health Service Users About the Use of Alternatives to Coercive Measures]. / Bitte macht (irgend)was! Eine bundesweite Online-Befragung Psychiatrieerfahrener zum Einsatz milderer Maßnahmen zur Vermeidung von Zwangsmaßnahmen.

Aim In recent years the legal basis in Germany for the use of coercive measures in psychiatry has changed. Now, coercive measures are permitted only as last resort after milder measures failed. However, there is no regulation of the type or amount of milder measures. In this study, we investigated which and how many milder measures were experienced by service users before coercion was used and which measures they value as potentially helpful to avoid it. Methods A sample of 83 service users was recruited. In an online survey the experience with 21 milder measures and their evaluation as helpful were assessed by self-report. Results On average, participants reported 5.4 experienced milder measures. The most frequent reason provided for why measures failed were structural factors, followed by staff behavior, and reasons caused by the participants themselves. The only milder measure rated by less than 50 % as potentially helpful in avoiding coercive measures was being persuaded to take medication.Conclusion Although many milder measures are perceived as potentially helpful, only few seem to be made use of in routine clinical practice. In order to prevent coercion staff members should apply a wider range of milder measures.

Implantación de una guía de buenas prácticas para la prevención de caídas: percepción de los pacientes hospitalizados y sus cuidadores / Implementation of a best practice guideline for the prevention of falls: Perception among hospitalized patients and its caregivers

Objetivo. Analizar la influencia que la implantación de una guía de buenas prácticas (GBP) para prevenir caídas podría tener sobre la percepción de pacientes hospitalizados y cuidadores respecto a los cuidados proporcionados durante el ingreso y la adherencia (grado de seguimiento) a las recomendaciones recibidas tras el alta. Material y método. Diseño. Estudio cuasiexperimental, que incluyó pacientes>65años ingresados durante≥48h en el área médica del Complejo Hospitalario de Albacete. Muestra. Ciento cuatro sujetos (muestreo consecutivo enero-marzo de 2013). Grupo experimental (GE): ingresados en unidades con implantación de GBP. Grupo control (GC): unidades con cuidados habituales. Variables. Caídas previas y durante ingreso; estado cognitivo (Pfeiffer); independencia en las actividades vida diaria; satisfacción con cuidados e información recibida, utilidad percibida, adherencia a las recomendaciones al alta. Fuentes de datos. Historia clínica y entrevista. Análisis estadístico. Descriptivo y bivariante. Riesgo relativo. IC 95%. Resultados. Ciento cuatro pacientes, GE 46,2% (48) y GC 53,8% (56). Mujeres 51,9%, edad media 79,9 años (d.t.=7,8). Pfeiffer 4,3 (d.t.=3,7). Caídas previas 31,1%. En seguimiento una caída por grupo. Diferencias estadísticamente significativas entre GE/GC: edad, estado cognitivo e independencia para las actividades de la vida diaria. En el GE fue superior el porcentaje de percepción sobre la utilidad de las recomendaciones para prevenir caídas (p<0,001), mayor adherencia (p=0,0002) y estar muy o suficientemente satisfechos con la información (p<0,00004) y los cuidados recibidos (p=0,002). Conclusión. Aplicar recomendaciones siguiendo una GBP para prevenir caídas en personas mayores ha mostrado en usuarios y cuidadores mayor satisfacción con la información, mejor percepción sobre su utilidad y mayor adherencia a las recomendaciones (AU)

Objective. To analyze the influence that the implementation of a fall prevention Best Practice Guideline (BPG) could have on the perception of patients and their caregivers about the utility of the activities implemented, about the care provided during admission and the adherence (the level of follow-up) to the recommendations received at discharge. Material and method. Design. Quasi-experimental study. Patients >65 years admitted≥48h to the Medical Area of the General Hospital of Albacete. Sample. 104 subjects (consecutive sampling January-March 2013). Experimental group (EG). Patients admitted to BPG implementation units. Control group (CG). Usual care units. Variables. Sociodemographic characteristics; previous and during admission falls, cognitive status (Pfeiffer); independence in daily life activities (ADLs); satisfaction with care and information provided, utility perceived, adherence to recommendations at discharge. Data sources. Interview and clinical history. Statistical analysis (SPSS 15.0). Descriptive and bivariant. Relative Risk. CI95%. Results. 104 patients, EG 46.2% (48) and CG 53.8% (56). Women 51.9%, average age 79.9 years (s.d.=7.8). Pfeiffer 4,3 (s.d.=3.7). Previous falls 31.1%. In process, 1 fall in each group. There were statistically significant differences between EG/CG: age, cognitive status and independence in ADLs. In the EG was higher the percentage of perception about the usefulness of the recommendations to prevent falls (P<.001), greater adherence to them (P=0.0002), and to be very or quite satisfied with the information (P<.00004) and care received (P=.002). Conclusion. To implement recommendations according to an Evidence-based BPG to prevent falls in older people has shown, in users and caregivers, greater satisfaction, better perception of its usefulness and greater adherence to the recommendations (AU)

The Relationship Between Nurse-Reported Safety Culture and the Patient Experience.

OBJECTIVE: The purpose of this study was to better understand the relationship between nurse-reported safety culture and the patient experience in a multistate sample of nurses and patients, matched by hospital unit/service line and timeframe of care delivery. BACKGROUND: Nurses play a key role in the patient experience and patient safety. A strong safety culture may produce positive spillover effects throughout the nurse caregiving experience, resulting in patient perception of a high-quality experience. METHODS: Multivariate mixed-effects regression models were specified using data from a multistate sample of hospital units that administered both the Agency for Healthcare Research and Quality (AHRQ) staff safety culture survey and the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient satisfaction survey over a 12-month period. Survey response variables are measured at the unit (service line) and hospital level. RESULTS: Key variables in the HCAHPS and AHRQ surveys were significantly correlated. Findings highlight the relationship between 3 safety culture domains: teamwork, adequate staffing, and organizational learning on the achievement of a positive patient experience. CONCLUSION: Modifiable aspects of hospital culture can influence the likelihood of achieving high HCAHPS top box percentages in the nursing and global domains, which directly impact hospital reimbursement.

Encuesta de satisfacción con el cuidado de la salud en las personas con enfermedad crónica / Survey of satisfaction with health care in people with chronic disease

Objetivo Desarrollar y validar la Encuesta de satisfacción con el cuidado de la salud para personas con enfermedad crónica no trasmisible (ECNT), para ser utilizada en el contexto Latinoamericano. Método: Estudio metodológico desarrollado entre 2012 y 2014. Para ello se cumplieron tres fases: 1) Revisión de la literatura relacionada con la satisfacción con el cuidado en situaciones de ECNT. 2) Estructuración de la propuesta preliminar de la «Encuesta de satisfacción con el cuidado de personas con enfermedad crónica», conocida como GCPC-UN-ESU. 3) validez fácil y de contenido con expertos 4) Prueba de campo en la aplicación a 111 personas con ECNT. Resultados: La encuesta GCPC-UN-ESU contiene 19 ítems y 4 dimensiones: satisfacción con los cuidados, con la educación en salud, con la calidad en el servicio prestado y el nivel de fidelización con el servicio. La encuesta en conjunto valora de manera integral la percepción de satisfacción con el cuidado de la salud por parte de las personas con ECNT, puede ser autodiligenciada. Conclusiones. La encuesta CPC-UN ESU fue validada y mostró contar con las variables necesarias para determinar el nivel de satisfacción de las personas con ECNT en el contexto de América Latina. Esta herramienta constituye una respuesta a las demandas de acreditación de los servicios en esta región (AU)

Objective: To develop and validate the survey of satisfaction with health care in people with non-communicable chronic diseases(NCDs), for use in the Latin American context. Method: This is a methodological study developed between 2012 and 2014, as part of the Latin American Network for Chronic Patient Care, under the Program for the Reduction of the burden of chronic disease in Colombia. Three stages were met: 1) Review of the literature on satisfaction with care in chronic diseases situations. 2) Structuring the preliminary proposal of the «Survey of satisfaction with health care in people with chronic disease» known as GCPC-UN-ESU and 3) facial validity and experts review 4) Test application to 111 people with NCDs. Results: The GCPC-UN-ESU, survey contains 19 items and 4 dimensions: satisfaction with care, with health education and with the quality of the service provided and the level of loyalty to the service. The survey holistically perceived satisfaction with health care by people with NCDs and it can be personally developed. Conclusions: The CPC-A ESU survey was validated and it had the necessary variables in order to determine the level of satisfaction of people with NCDs in the Latin American context. This tool is a response to the demands of accreditation services in this región (AU)

Impacto de la metodología Lean en la mejora de procesos asistenciales y niveles de satisfacción en la atención de pacientes en un laboratorio clínico / Impact of Lean methodology to improve care processes and levels of satisfaction in patient care in a clinical laboratory

Introducción. La aplicación de la metodología Lean en las instituciones de salud es una herramienta efectiva para mejorar la capacidad y el flujo de trabajo, así como para incrementar el nivel de satisfacción de pacientes y empleados. Objetivo. Optimizar el tiempo de atención de los pacientes ambulatorios en un laboratorio clínico mediante la implementación de una metodología basada en la organización de procesos operativos, para mejorar la satisfacción del usuario y reducir el número de quejas por demoras en la atención. Materiales y métodos. Se implementó un estudio cuasi experimental de antes y después, realizado entre octubre de 2011 a septiembre de 2012. Se emplearon gráficos X Barr y S para observar los promedios en los tiempos de atención y su desviación estándar. La satisfacción de los usuarios se evaluó mediante encuestas de servicio. Resultados. Se observó una disminución de hasta 9 min en los tiempos de atención de los pacientes, desde su llegada hasta su salida del laboratorio, y una disminución del 73% en las quejas por demora en la atención. A pesar de la alta rotación del personal y del incremento del 38% en el número de pacientes atendidos, se adquirió una cultura de empoderamiento y mejora continua, así como mayor eficiencia y productividad en el proceso de atención; lo cual se vio reflejado por el mantenimiento de los estándares 12 meses después de la implementación. Conclusión. La metodología Lean es una herramienta viable para mejorar los procesos de los laboratorios clínicos, mejorando su eficiencia y eficacia (AU)

Introduction. The application of the Lean methodology in health institutions is an effective tool to improve the capacity and workflow, as well as to increase the level of satisfaction of patients and employees. Objective. To optimise the time of outpatient care in a clinical laboratory, by implementing a methodology based on the organisation of operational procedures to improve user satisfaction and reduce the number of complaints for delays in care. Material and methods. A quasi-experimental before and after study was conducted between October 2011 to September 2012. XBar and S charts were used to observe the mean service times and standard deviation. The user satisfaction was assessed using service questionnaires. Results. A reduction of 17 minutes was observed in the time of patient care from arrival to leaving the laboratory, and a decrease of 60% in complaints of delay in care. Despite the high staff turnover and 38% increase in the number of patients seen, a culture of empowerment and continuous improvement was acquired, as well as greater efficiency and productivity in the care process, which was reflected by maintaining standards 12 months after implementation. Conclusion. Lean is a viable methodology for clinical laboratory procedures, improving their efficiency and effectiveness (AU)