access, ambulatory care, process improvement, Six Sigma, specialty referral



  1. Deckard, Gloria J. PhD
  2. Borkowski, Nancy DBA
  3. Diaz, Deisell PhD
  4. Sanchez, Carlos MBA
  5. Boisette, Serge A. MHSA


Designated primary care clinics largely serve low-income and uninsured patients who present a disproportionate number of chronic illnesses and face great difficulty in obtaining the medical care they need, particularly the access to specialty physicians. With limited capacity for providing specialty care, these primary care clinics generally refer patients to safety net hospitals' specialty ambulatory care clinics. A large public safety net health system successfully improved the effectiveness and efficiency of the specialty clinic referral process through application of Lean Six Sigma, an advanced process-improvement methodology and set of tools driven by statistics and engineering concepts.