proactive office encounter

The staff at the Radiation Oncology department at the Los Angeles Medical Center knew well the importance of identifying cancer early.

It was part of their clinical routine, and when necessary, they knew patients could begin treatment and slow the spread of the disease.

“We see what happens when you don’t screen regularly,” says Sandra Miller, the department administrator and the UBT’s management co-lead.

So, the UBT was determined to deliver on Kaiser Permanente’s promise of preventive care and leverage the Proactive Office Encounter to increase the percentage of regularly scheduled mammograms, colorectal and Pap screenings by December 2013. 

“With Proactive Office Encounter, we are treating the whole member,” says Maria Caceres, an assistant department administrator who was involved with the improvement project.

But the team also had to overcome resistance from patients.

“I think most of our patients that come to us do not want to deal with [one more test],” says union co-lead and medical assistant Monica Villanueva, SEIU UHW. “However, the more we reinforce the importance of having it done, they are more willing.”

Electronic reminders on KP HealthConnect helped ensure patients were getting their screenings, but the team also used a process map to examine its own workflow.

They put color-coded sheets on providers’ keyboards in exam rooms as visual alerts to indicate a patient is due for a screening (pink for mammogram, orange for colorectal test, green for Pap test) and created a pending order in KP HealthConnect.

Medical assistants checked the Proactive Office Encounter before each appointment to alert physicians when screenings were needed, and to check results and make reminder calls to patients.

They gave staff access to the radiology department’s appointment system so appointments could be made for patients while they were in the office, and provided training by laboratory colleagues on how to instruct patients on using the Fecal Immunochemical Test (FIT) kits.

“We had to sit down and break down every step,” Miller says. “We would ask, ‘Where were we not taking advantage of an opportunity to communicate with the doctor or the patient?’ Our process really changed after that.”

As a result colorectal screenings improved by 25 percentage points, Pap smears got a 12-point bump and mammograms increased by 46 points.

And when results for two patients showed they had additional health issues, the physicians, employees and managers were convinced.

“They could see the value and the impact of their hard work,” Caceres says.

The team in the Head and Neck Surgery/Audiology department at the South Bay Medical Center had been compiling monthly reports about missed second blood pressure checks.

And this can be a critical point for a patient’s care because high blood pressure is often called “the silent killer.” Those who have it often don’t exhibit symptoms until it’s extremely high, and untreated hypertension can lead to heart disease, stroke and kidney problems.

But the team reviewed the numbers without a follow-up plan.

So, they decided to have morning huddles several days a week to explain the screenings and follow with plans of action.

“We discuss why this is important and what it means to our members, that it can save lives, especially for those who haven’t been diagnosed,” says Kathy Malovich, the department administrator. 

UBT leaders provided team members with their individual performance scores on administering needed second blood pressure tests. They customized training and other follow-up plans, including coaching the team on procedures for Proactive Office Encounters (a process that takes advantage of a member’s visit to ensure the member gets any needed tests or appointments).

At huddles, they discussed the importance of controlling high blood pressure for patients. They emphasized that not only was it a strategic clinical goal but a Performance Sharing Program (PSP) goal for the medical center.  

“People think they’ve done the second test because they know they should have,” says Leroy Foster, who was the department administrator when the test of change began. “Maybe they got distracted by any number of things.” Foster said the hard data helped motivate the team. 

With a low of 35 percent for second blood tests, each team member jumped to 92 percent or better in a year. Four of the six team members hit 100 percent. In 10 months, team scores for second blood tests went up from 84.8 to 92.1 percent.

Huddling was also a key to success.

“I used to think, ‘you guys have way too many meetings,’” Jennell Jones, the union co-lead, says. “But now I see how meeting keeps people connected.”