Practicum Highlight: Sarah Auletta, MPH ’26
Applying Lean Six Sigma to Optimize Pediatric Liver Transplant Workflows at Boston Children's Hospital
Sarah Auletta, an Online Hybrid MPH candidate at Dartmouth’s Geisel School of Medicine, is using her Integrated Learning Experience (ILE) to examine how hospital workflows can be optimized to improve access to life-saving care for pediatric patients. Her project focuses on the liver transplant pathway at Boston Children's Hospital, where she applies Lean Six Sigma methodology to identify and reduce delays in the process from referral to waitlist activation.
For children with end-stage liver disease, a liver transplant is often the only curative option. However, the pathway to transplant is complex and time-sensitive, often marked by delays. While organ availability remains a broader challenge, Sarah’s work highlights how internal hospital processes play a critical role in determining how quickly patients are able to access the transplant waitlist.
Using a convergent mixed-methods approach, Sarah analyzed more than five years of referral data from the Epic electronic health record system and interviews with professionals across all twelve disciplines involved in the transplant continuum. Her findings revealed that a median of 64 days elapsed between referral and waitlist activation, a period shaped by operational workflows within the hospital. Key bottlenecks included evaluation scheduling, insurance authorization, and the timing of selection committee reviews.
To address these challenges, Sarah developed a comprehensive current-state process map in close collaboration with frontline staff, making inefficiencies visible to the multidisciplinary team for the first time. She also created a structured Excel dashboard to support ongoing monitoring of each phase of the process. Together, these tools provide a practical, data-driven framework that can be used to improve efficiency, reduce time to listing, and ultimately enhance patient outcomes. The approach is designed to be replicable across transplant programs and other areas of complex care delivery.
Throughout her project, Sarah has drawn on the collaborative environment at Dartmouth, including partnerships with biomedical research librarians and feedback from interdisciplinary experts who helped strengthen her analysis and approach. Her work underscores the value of combining data, systems thinking, and cross-team collaboration to drive meaningful improvements in healthcare delivery.
“Working on this project has shown me how much opportunity exists within healthcare systems to improve patient outcomes by examining and refining processes,” Sarah shares. “Through my time at Dartmouth, I’ve been able to collaborate with incredible mentors and resources, including biomedical research librarians and interdisciplinary experts, who consistently challenged me to think critically and consider new perspectives.”
Written by: Mia Soucy
POSTED 4/2/2026 AT 02:04 PM IN #practicum #mph #2026
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