1. The Research Question
Using Lean Management to Improve Opioid Prescribing for Pain in Ambulatory Care
Connie van Eeghen DrPH, Amanda Kennedy PharmD, Mark Pasanen MD, Benjamin Littenberg MD, Charles MacLean MD
University of Vermont
The Question: Is a structured, systems-based QI method, such as Lean, effective in helping practices implement a set of best practice strategies?
Why this is important:
Increased prescription pain relief drug diversion/addiction
Structured problem-solving approaches such as Lean have potential to improve many primary care processes

2. What the Researchers Did
Engaged 9 primary practices & 1 orthopaedic practice in Lean redesign of office work
Mixed methods, prospective, observational
Multiple case studies paired pre- and post-intervention surveys from providers and staff
155 study participants; 77% response rate
36 prescribers and 83 staff responded (n=119)
Primary outcome: provider satisfaction with opioid prescription management

3. What the Researchers Found
Satisfaction (2 bars), selected strategies (3 bars), prescriber confidence (4 bars)

4. What This Means for Clinical Practice
The Lean approach embedded key strategies into office work successfully. Most common:
Use of state-sponsored prescription data base
Provider/staff team approach to managing Rx
Consistent approach across entire practice
Lean was effective and well-received regardless of the specific strategies selected
A toolkit to guide the use of Lean in primary care may have broad application