Practice Management Workshop

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Practice Management Workshop

• July 9-11, 2004
• The Westin OHare Rosemont, IL

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Office Flow and Patient Satisfaction

• Andrew Green, MD, FAAAAI
• Kathleen Conboy-Ellis, ARNP, PhD, FAAAAI
• Clifford H. Meyer, MBA, CMPE

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Patient Satisfaction- What Do They Want/Need

• Patients are our Customers and their Needs
• Should Drive our Practice

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Patient Satisfaction - What Do They Want/Need
continued.

• To get into the practice in a timely fashion when
  they are new patients
• To get into the office within a reasonable time
  when they have exacerbations

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Patient Satisfaction - What Do They Want/Need
continued.

• To be called by name
• To be treated with respect
• To be greeted warmly by front office staff- to
  feel welcome

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Patient Satisfaction - What Do They Want/Need
continued.

• To have their registration information taken in
  advance
• Not to have long waits just sitting in waiting
  room
• To go back and talk with nursing staff before
  seeing physician to be assessed for severity of
  disease (questionnaire, spirometry etc.)

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Patient Satisfaction - What Do They Want/Need
continued.

• To have a partnership with the physician and
  health care providers (HCP)
• To have uninterrupted time with physician/HCP
  focusing on their concerns
• To be educated on how to use medications,
  inhalers, devices, peak flows

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Patient Satisfaction - What Do They Want/Need
continued.

• To have all questions addressed
• To leave with a written action plan

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Patient Satisfaction - What Do They Want/Need
continued.

• To have phone numbers to call in an emergency
  situation
• To know refill times/call in times
• To have access to talk to or email a nurse or
  physician between visits

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Patient Satisfaction - What Do They Want/Need
continued.

• To have the opportunity attend classes-
  individual or group sessions to cope with their
  chronic illness
• To be given written teaching sheets on various
  aspects of disease management such as How to use
  your MDI

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Patient Satisfaction - What Do They Want/Need
continued.

• Want exit interview /appointment or instructions
  on follow- up
• To be asked when they leave if their needs have
  been met

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Patient Satisfaction - What Do They Want/Need
continued.

• Patients needs can be met better in an office
  thats efficient, organized and flows well.

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OFFICE FLOW PATIENT SATISFACTION

• THE DOCTORS PERSPECTIVE

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Institute For Healthcare ImprovementIdealized
Design of Clinical Office Practices (IDCOP)
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IDCOP Seeks To Improve

• Access
• Clinical outcomes
• Patient satisfaction
• Operational efficiency
• Provider-Staff satisfaction
• Financial performance

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Principles of IDCOP

• Care is based on a continuous healing
  relationship
• Customized care is based upon patient needs and
  values
• The patient is the source of control
• Shared knowledge and free flow of information
• Care based on best practices delivered
  consistently

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Principles of IDCOP continued.

• Reduce risk through care delivery systems
• Patients should receive information to make
  informed health care choices
• Anticipate patient needs
• Avoid wasting resources or time
• Timely exchange of information and coordination
  of care among providers

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IDCOP Themes

• ACCESS the patients ability to get into the
  system
• INTERACTION what happens when the patient is in
  the system
• RELIABILITY the patient getting the care they
  need
• VITALITY the can do spirit and continuous
  focus on how to improve patient care

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Access

• Measure backlog by 3rd available appt.
• Bring capacity in line with demand
• Increase Capacity
• expand hours
• add staff
• adjust schedules
• Reduce Demand
• extend follow-up interval or discharge patient
• do more at one visit
• use nurse staff to provide some services
• create non-visit interaction (e-care)

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Access continued.

• Measure flow times through the office visit
• Match scheduled time with cycle time
• Reduce wasted time
• paperwork bottlenecks
• duplication of work
• too many hand-offs
• Improve value-time
• evaluation
• treatment
• education

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Interaction

• Measure patient satisfaction of
• explanations of care
• visit quality
• would they recommend the office to others
• patient delight
• Indicators of problems
• patient non-compliance
• no-shows or transfers out
• lack of understanding of treatment
• complaints of too little time given

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Interaction continued.

• Indicators of good interaction are
• Clinical issues are understood and accepted
• Clinical management is evidence based
• Patients and doctors set goals and solve problems
• Care plans are shared and there is appropriate
  follow up

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Interaction continued.

• Features of good interaction
• Customized communication
• Alternative ways to communicate available
• informational materials online
• telephone information
• teams in the office to meet needs
• email
• scheduled interaction online or phone

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Reliability

• Definition Exactly the help I need and all and
  only the care I need
• Problems
• Failure to use best-practice guidelines
• Failure to monitor compliance and outcomes
• Failure to identify ineffective treatment
• Variability of treatment within the practice

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Reliability continued.

• Asthma as an example
• Are asthma care guidelines followed?
• indicators of severity documented in record?
• Objective pulmonary measurements done?
• Medication use documented?
• Action Plans issued?
• Are patients monitored?
• Periodic review of immunotherapy patients?
• Is there communication with primary doctors?

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Vitality

• Definition an office culture that continuously
  innovates and improves care to patients and
  always sees things through the eyes of the
  patient
• How measured satisfaction of staff with their
  jobs and feel dedicated to their profession and
  the practice and are enthusiastic about
  continuously improving care to patients

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Vitality continued.

• States goals/objectives measures progress
• Strong, visible leadership and structure
• Promotes work in teams, communicates among each
  other and gives feedback
• Empowers staff and delegates tasks
• Measures staff satisfaction of
• morale
• empowerment
• stress
• would recommend office to family

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Satisfied Doctors

• Were going in the right direction now.
• My job is more complete.
• I am practicing better medicine.
• I bring higher value care to my patients.
• I am more relaxed.

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How Important is the Appointment Schedule?

• When it isnt working!
• Chaos loss of control
• Poor patient service satisfaction
• Lower physician/staff productivity
• Higher frustration
• Decline in practice profits

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Recognizing Signs of Trouble

• Running behind schedule
• Patients arriving late
• Physicians arriving late
• Cancellations no shows
• Patient staff complaints
• Inconsistent charge patterns

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Examining Scheduling Issues

• Over booking
• Under booking
• No shows
• Late cancellations
• Unrealistic scheduling
• parameters
• The 15 minute appointment
• Lack of flexibility

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Document Current Scheduling Patterns

• Create appointment scheduling diary for ten
  consecutive days
• Involve
• Front office staff
• Clinical staff staff
• Document
• Activities / problems

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Analyze the Current Schedule Results

• Appointment scheduling diary
• Review activities problems that emerged
• Identify and assess
• Internal reasons for delays
• External reasons for delays
• What is controllable what is not

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The Virtual Patient -- Phone Calls

• Track volume
• Analyze reason for calls
• Is it necessary?
• Was patient in recently?
• Could this have been resolved then?
• Is this a repeat call
• Resolve the first time
• Look for ways to reduce calls

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Examining Current Scheduling Productivity

• Conduct time and motions study
• Track time spent with each patient encounter
  (three day period)
• Involve all providers
• Objectives
• Improve efficiency and time management
• Improve profitability
• Improve patient satisfaction

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The Time and Motion Tracking Tool

• Create routing form (5x8) that includes
• Scheduled appointment time time allotted
• Patient name, age payer type
• Tracking time
• Arrival, patient roomed
• Physician enter / exit room
• Patient check-out
• Comment area This is critical

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Analyze the Time and Motion Study

• Delays in patient activity
• Physician actual time with patients
• Physician transition time
• Time needed
• Time wasted
• Clinical factors

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Time and Motion Analysis

• Physician lost time
• Lack of delegation
• Inhibitors
• Valid (uncontrollable)
• Invalid (controllable)

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Taking Action

• Creating realistic scheduling templates
• Expect the unexpected
• Implement with accountability
• Physician and staff
• Establish daily productivity goals

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Monitor Results

• Measure performance against goals
• Objective findings
• Conduct follow up studies in 3-4 months
• The real data
• tells the real story

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Taking Your Success to the Next Level

• Patient satisfaction
• Set (measurable) goals for wait time
• Set (measurable) goals for access time
• The added benefit
• Increased productivity
• and higher profits

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The Competitive Advantage

• Meeting satisfying patient needs
• Establish mechanism to measure
• Conduct patient satisfaction studies
• Respond to the results by raising the bar
• Always seek to improve service