Title: Practice Management Workshop
1Practice Management Workshop
- July 9-11, 2004
- The Westin OHare Rosemont, IL
2Office Flow and Patient Satisfaction
- Andrew Green, MD, FAAAAI
- Kathleen Conboy-Ellis, ARNP, PhD, FAAAAI
- Clifford H. Meyer, MBA, CMPE
3Patient Satisfaction- What Do They Want/Need
- Patients are our Customers and their Needs
- Should Drive our Practice
4Patient 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
5Patient 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
6Patient 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.)
7Patient 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
8Patient Satisfaction - What Do They Want/Need
continued.
- To have all questions addressed
- To leave with a written action plan
9Patient 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
10Patient 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
11Patient 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
12Patient Satisfaction - What Do They Want/Need
continued.
- Patients needs can be met better in an office
thats efficient, organized and flows well.
13OFFICE FLOW PATIENT SATISFACTION
14Institute For Healthcare ImprovementIdealized
Design of Clinical Office Practices (IDCOP)
15IDCOP Seeks To Improve
- Access
- Clinical outcomes
- Patient satisfaction
- Operational efficiency
- Provider-Staff satisfaction
- Financial performance
16Principles 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
17Principles 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
18IDCOP 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
19Access
- 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)
20Access 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
21Interaction
- 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
22Interaction 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
23Interaction 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
24Reliability
- 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
25Reliability 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?
26Vitality
- 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
27Vitality 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
28 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.
29How 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
30Recognizing Signs of Trouble
- Running behind schedule
- Patients arriving late
- Physicians arriving late
- Cancellations no shows
- Patient staff complaints
- Inconsistent charge patterns
31Examining Scheduling Issues
- Over booking
- Under booking
- No shows
- Late cancellations
- Unrealistic scheduling
- parameters
- The 15 minute appointment
- Lack of flexibility
32Document Current Scheduling Patterns
- Create appointment scheduling diary for ten
consecutive days - Involve
- Front office staff
- Clinical staff staff
- Document
- Activities / problems
33Analyze 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
34The 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
35Examining 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
36The 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
37Analyze the Time and Motion Study
- Delays in patient activity
- Physician actual time with patients
- Physician transition time
- Time needed
- Time wasted
- Clinical factors
38Time and Motion Analysis
- Physician lost time
-
- Lack of delegation
- Inhibitors
- Valid (uncontrollable)
- Invalid (controllable)
39Taking Action
- Creating realistic scheduling templates
- Expect the unexpected
- Implement with accountability
- Physician and staff
- Establish daily productivity goals
40Monitor Results
- Measure performance against goals
- Objective findings
- Conduct follow up studies in 3-4 months
- The real data
- tells the real story
41Taking 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
42The 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