Patient satisfaction is the primary goal for Family Practice of Holyoke Medical Clinic. Steps being taken toward that goal were summarized at the June 23 meeting of East Phillips County Hospital District Board.
A Lean Six Sigma team within Melissa Memorial Hospital and the clinic have been working on strategies for this goal and collecting data for six months.
Hospital Administrator John Ayoub introduced the LSS team at last week’s board meeting. They include Sheila Robinson, team leader and clinic manager; Heather Kellan, clinic front office supervisor; John Durbin, back office liaison to the team; Melissa Mayden, information technology/data person; and Deaun Carpenter, provider.
Ayoub explained that Lean Six Sigma is a statistical-based methodology that shows changes made and results that came because of those changes.
With regard to the medical clinic, he said they want to make sure that patients have access to the health care providers. He pointed out that the providers work hard. They’re not asking them to work harder but to work smarter — to change the process being used.
“We want to make sure we don’t negatively impact the quality of care,” Ayoub emphasized.
Citing the May 26 board meeting where a number of community members expressed displeasure with clinic procedures, Ayoub said that the clinic schedule for May wasn’t available even at the end of April.
“I take full responsibility,” said Ayoub, adding that he thinks that’s what escalated the concern in community members’ minds.
What’s important to note is that the scheduling-ahead issue has been remedied. Ayoub said they are now scheduling 60 days out and hope to make that 90 days out soon. The ultimate goal is to get to 120 days out for scheduling with specific providers.
Robinson reiterated that appointments are being scheduled 60 days out, through mid-August.
Ayoub cited that part of the issue is that a number of providers are working hard to do other things in addition to seeing patients in the clinic — all significant outreach for the hospital and clinic as a whole.
In particular, he mentioned Carpenter’s Wednesday Coumadin clinics that draw 30-40 patients each time. Other extra duties include wound-care clinics, nursing home visits, diabetes education, participation in surgery and walk-in clinics.
Introducing the Lean Six Sigma concept, Robinson explained it’s an efficient way of solving problems or doing new things. LSS solutions are lean, customer-focused, money-focused, staff-focused and well-managed.
Keeping on track with the clinic study, Robinson cited the five phases are to define, measure, analyze, improve and control.
They’ve defined that providers should see more patients, and the LSS team will continue to look at progress and make changes, will review data for improvement, and will continue to control stable processes and try new things as well.
The LSS team identified that customers get value when they have enough face time with a provider, get timely results on diagnostic tests and get a correct and understandable bill.
On the other hand, value is destroyed if customers have to wait, there are no call-backs, no test results, no prescription refills or rude treatment.
Addressing “where to go from here,” Robinson said they will work through what Carpenter has labeled time bumps.
This will be in an effort to increase capacity through improved scheduling, improved workflow and support of providers. Additionally they will look to increase providers’ capacity to see patients to increase number of patient visits per year.
Kellan reported on changes that have been implemented to push for patient satisfaction.
Previously, the regular schedule accommodated 13 patients per day per provider. With no-shows, the average was 9.5 per day. Patients would arrive up to 10 minutes late, causing the remaining schedule to be delayed.
Now, patients are asked to arrive 15 minutes early to check in, the schedule is more flexible to allow room for continuity, and the average wait in the lobby is reduced to approximately 15 minutes.
Walk-in clinics are now on a structured schedule rather than on a first-come, first-served basis. Previously, patients would arrive in groups and have extended wait times, and there were times that not all patients could be seen.
Now, with the structured walk-in clinic schedule, extended wait times have been eliminated, and the clinic still accommodates 16-20 patients per day.
Another change in the walk-in clinics is that they’re telling people who the walk-in provider will be for each particular day’s clinic.
In terms of becoming more productive, Kellan said they sat down with providers to assess visits and determine necessary appointment lengths rather than scheduling every standard appointment as a 30-minute visit.
The front office is asking more questions when scheduling in order to assess the potential time needed for the appointment. Kellan emphasized that they’re definitely not trying to diagnose but are simply assessing the time needed with the provider and saving time by getting crucial information in advance of the appointment.
For instance, she said for an X-ray order, they need to know which finger on which hand. So they do ask a lot of probing questions, but in no way do they diagnose.
They’re looking to obtain notes for follow-ups as well as immunization records prior to visits and to screen patients to determine if labs/X-rays are needed so orders can be obtained.
Additionally, Kellan said front-office staff are sending electronic telephone messages to the back office staff to reduce the time spent on the phone. They’re also being mindful of patient privacy when reviewing paperwork.
From the back-office perspective, Durbin cited the nursing checklist that has been established for better efficiency. The big one is the huddle each morning to go over each provider’s schedule for the day.
Rooms are stocked with supplies daily, and the nursing staff communicates with providers about tests that they can do and prep work they can finish to assist providers with patient care.
Communication between the front and back offices has improved tremendously as a result of prioritized changes in procedures.
Robinson noted that nurses also need to ask questions of patients calling in, in order to determine the length of appointment required. “That’s how we become more productive.”
Mayden reviewed data for each provider that is charted to determine where changes need to be made. She referenced the days to third next available appointment. One person may call in and get a slot from a recent cancellation, so that’s not realistic in terms of how long they had to wait to get an appointment with a provider.
The data that is kept is the third caller and the time element involved in getting the next available appointment. Standard third next appointment is six days, but they’re shooting for three to five days for the third next available appointment.
Mayden shared statistical analysis graph reports for each provider on days to third next appointment, appointments scheduled and canceled, appointments kept and number of no-shows. These reports are run each week, she added.
She cited the overall impact when providers are on vacation or continuing medical education.
Carpenter noted that in the clinic, they’ve added a reading room for viewing digital images from the diagnostic imaging department so that providers don’t have to go clear across the facility to the lab for those results. That’s saved time.
Additionally, other people are doing paperwork, logging the testing that was done at appointments so that providers don’t have to do that themselves.
Board members asked questions concerning privacy and staff capability of completing paperwork. Kellan emphasized that the front office staff takes face-to-face patients in a more secluded area if they’re visiting about more sensitive information. By phone, they’re not identifying patients by name so that others in the vicinity could overhear private information.
Carpenter assured that the paperwork done by others involves logging details of testing completed to record that it indeed did happen at that appointment, and it is certainly within their scope of capability.
Carpenter cited the discouragement that she and other providers felt after learning about the community comments at the May board meeting.
She emphasized that she wants to meet the criteria cited but certainly with good patient care. She said she’s had variable results ranging from days that she’s caught up to days that she’s way behind in charting. She’s trying some new things — some are working, others are not.
She described several “time bombs” that happen on a typical day — situations that play havoc in a structured schedule. She added that she wishes everyone could walk through a standard day with her to have a better awareness of the types of things that impact a provider’s schedule.
Responding to Carpenter’s question about the goal for the providers, Ayoub cited the strategic plan. He added that most of the work they’ve been doing with Lean Six Sigma has centered on making providers more productive by changing processes so they can see more patients without compromising quality care and without overworking them any more than they already do.
Holyoke Enterprise July 2, 2015