FRAM and LEAN as tools for describing and improving the referral process between outpatient clinics in a Danish Hospital: complementary or conflicting?

In Denmark, outpatient specialist care is delivered at hospital-based outpatient clinics for non-acute patients. The specialist can also refer patients to other specialists for diagnoses and treatment. The referral process of patients between the internal medicine specialist outpatient clinics at the University Hospital of Southern Denmark is inefficient which is resulting in unnecessary inter-departmental referrals. These outpatient clinics are; nephrology, cardiovascular, endocrinology and pulmonology. The findings from our recent register study “Today’s referral is tomorrow’s repeat patient” showed that one-third of all referrals are from internal sources, and can potentially be avoided. An inefficient referral process means; a) ineffective use of physician and hospital service, and b) over testing and repetitive testing. The goal of the managers at the Hospital is to understand the referral process and identify quality improvements(QI) to reduce unnecessary internal referrals for the benefit of patients and healthcare professionals.