Establishing a School Clinic

Using Lean Principles to Value Purpose

Kelly Gonzales


Nurs Econ. 2018;36(5):225-232. 

In This Article

Abstract and Introduction


WHILE NURSE-LED CLINICS are not new, changes in state practice acts allowing advanced practice nurses to function with a full scope of practice are providing expanded opportunities for clinic development. Clinic locations are also changing, and while clinics are still in traditional settings such as community-based health centers, clinics are additionally in pharmacies, grocery stores, schools, churches, and other social gathering places. Collectively, these opportunities are improving access to urgent and primary care. Within this context, the author had the opportunity to open a school-based satellite clinic linked to a Federally Qualified Health Center (FQHC), and was eager to represent the partnership between the local school district and the FQHC.

It was soon realized that venture development was not central to the author's doctoral education. A review of the literature led to the discovery of Lean principles, which proved useful to clinic establishment. In retrospect, the initial inclusion of Lean principles before establishing the school clinic would have been beneficial for ultimate success. However, application of Lean principles was not part of the initial planning or performed before opening the school clinic. Therefore, use of Lean principles did not serve as a guide for this experience, but rather as a means of framing reflections. The purpose is to share pearls and lessons learned for anyone considering establishing a clinic using Lean principles of purpose, people, and process, and to share specifics from creating a school clinic from the initial planning stage and during the first 2 years of the school clinic being operational.