Case Studies

Lean Healthcare: Utilization Review


Less than 100% of daily Utilization Reviews (UR's) are being submitted before 5pm each day.


The Lean team conducted a problem solving using the A3 as a guide to take a deep dive to understand the problem from all perspectives that affect the Utilization Review process. Using the PDCA methodology, there was a lot of analysis of data, front-line observation and information gathering. Many areas were identified for improvement based on the information gathered and performing a waste analysis on their process. Lean tools and philosophies, such as Standard Work, were used to eliminate those wastes and improve the ability to complete the daily requirement for UR's.


  • Reduced morning set-up time by 50%, saving up to 1 hour per Care Manager
  • Developed and implemented a Standard UR process for all Care Managers, which reduced the time to complete an average UR by at least 30% based on a typical work load for a Care Manager equates to 1.8 hours per Care Manager per day
  • Standardized clinical content for each UR
  • Developed a consistent and defined training process for new Care Managers
  • Started daily huddle with each Care Manager Service line.