Date of Award

Fall 2023

Project Type

Clinical Doctorate



Program or Major


First Advisor

Marjorie Godfrey

Second Advisor

Cathleen Colleran


Background: A community-based non-emergency walk-in clinic in Southern New Hampshire experienced high volume and inefficient workflows during the pandemic, causing delays in care, long visit times, and low net promoter scores.

Purpose: Institute an evidence-based approach to improve work efficiency through innovative models of care.

Methods: A literature review on best practices for workflow redesign guided the project. The project instituted an on-demand telemedicine service and a clinic fast-track workflow. A mixed methods approach analyzed pre /post cycle times, net promoter scores, and themes from staff interviews. Pre/post cycle times analyzed 12,767 completed appointments.

Results: There was a statistically significant improvement in cycle times, with a P-value of < .0001. Door-to-door time decreased by 26%, waiting room time decreased by 56%, net promoter scores improved by 12.5%, and there was a 30.5% improvement in the percentage of appointments ≤ 60 minutes. 6.4% of patients were booked for telemedicine visits to offload clinic volume. Themes from the semi-structured interviews revealed supportive themes around improved workflow and communication and disruptive themes around nurse visits for telemedicine testing, EHR scheduling, and feelings of burnout.

Conclusions: There was improved clinic efficiency and ability to meet volume demands. The interventions contributed to these improvements. Additional studies that evaluate project effectiveness over time to account for seasonal variability, patient acuity across multiple sites, and the impact of workflow changes on staff burnout are indicated.

Included in

Nursing Commons