Response

摘要

We appreciate the response to our research and the opportunity to respond. Although we understand the concern about the Hawthorne effect being the likely reason for our findings, we disagree that this effect is a possible explanation for several reasons. First, given the magnitude of the assessment wait time improvement, which did not diminish over time, was immediate, and was persistent across 67,939 patient interactions and 10 postintervention months, it is unlikely that this improvement was due to the Hawthorne effect. Second, the clinic staff of approximately 150 people was not made aware that the process implementation was being studied or was experimental, because the data were obtained and evaluated retrospectively.