Single PowerPoint slide showing how PT/OT team in the Northwest improved its work process to spend more time with patients.
This poster highlights a team of receptionists in the Northwest that found a way to improve customer service.
Medical Assistant Kris Gardner shares a patient interaction tip.
Registration reps at two medical offices in the Northwest were struggling to get their work done.
Their job aids were inadequate. And these can prove critical in busy clinics, by providing help with tasks like adding a walk-in patient to the schedule, incorporating additional insurance information or processing payments.
But disorganization, improper documentation and an unclear process meant staff members frequently had to stop and interrupt a co-worker (slowing his or her work down) to find out how to do such tasks—all while the member waited.
So staff members started a “plan, do, study, act” improvement process.
As a first step, they held a meeting and registration representatives brought all their job aids from their desks, often just stacks of paper in no particular order. In the meeting, they tried to find specific documents and were timed.
The average time it took to locate a document was 26 seconds, and worse, the reference document often couldn’t be found.
The team decided to organize their job aid books in a consistent manner. No matter where a registration representative was sitting, every book was the same. Staff also created instruction sheets on some processes that complemented the job aids.
Included in the new policy and procedure binders were colored job aids with cover sheets in alphabetical order, and also a step-by-step instruction sheet.
“We’ve heard nothing but good feedback from doing this improvement,” supervisor Colleen Moore says. “Staff have more confidence because they are figuring out the answers to their questions instead of asking.”
After implementing the changes, the team tested the process again and located the correct reference document each time in an average time of three seconds.
Interested in a quick and easy check in next time you go to the doctor? Registration representatives in the Northwest found that getting organized helped them help the patient better.
EVS workers and managers are tasked with keeping KP's facilities clean and germ free, but these departments are prone to lots of injuries. Find out in this story from the Summer 2010 issue of Hank how some of these departments are doing what it takes improve workplace safety.
The MRI unit at Kaiser Sunnyside Medical Center had a challenge.
The department was receiving an average of 120 cases each day, but they were able to see only 71. As a result, patients were being referred outside of the Kaiser Permanente system. This drove up referral costs, inconvenienced KP members, and increased dissatisfaction.
In addition, referring patients to outside services posed a delay in getting results back to the ordering doctors. Schedulers who received the request for appointments also had a tough job—when they were not able to accommodate patients within the KP system, they had to make arrangements with outside services, which took additional time.
And finally, the patients didn’t like it.
The feedback from patients to department manager David Barry, was that they didn’t want to have to go elsewhere for services. Patients preferred to have their MRIs performed at the Sunnyside Medical Center.
The team's first step was to increase capacity to see more patients and reduce outside referrals by at least 10 per week within two weeks. To acccomplish this, they reduced the overlap in staffing and changed the schedules of two technologists, increasing their ability to see more patients.
The new staffing schedule, which didn’t infringe on union contracts, came out of a brainstorming session and was supported by staff and physicians.
After the first two technologists adjusted their schedules, a third technologist, seeing the difference it made, offered to adjust his schedule. By the end of one week, about 15 more patients were added to KP’s schedule and not referred to outside services. This resulted in a cost savings of about $7,500 per week, or about $30,000 per month.
"One of the big advantages that we have found is that we have openings for certain appointment types within a day or two, not a week or two," says labor co-lead Heather Thompson.
In addition to the work done in the UBT, a mobile scanner was added to the department. This enabled an additional 11 patients per day to be seen—or about 55 patients per week—for an additional per week savings of $30,000 in outside referral costs.
"There is a downside to that, though,” Thompson says. “Since patients are able to get the appointment so quickly, it seems as though we have a lot more short-notice cancellations and we do not have a wait list to fill them with. That is something that we will need to monitor and try to come up with a solution to."
Sunnyside Medical Center's MRI department was receiving more cases each day than it could handle.
The Mammography Department at Sunnyside Medical Center was seeing about 370 patients per week, but 25-30 percent of those appointments were running behind schedule.
Appointments ran late because information was missing from the file, additional forms were needed or the wrong test had been ordered. This cost the technologist additional time tracking down information or following up on needed documentation during the patient’s appointment, which had a cascading effect.
The unit-based team (UBT) realized that many of the issues causing delays during appointments could be handled in advance of the patient's arrival. The team came up with the idea of setting time aside every afternoon for a technologist to review the following day's orders.
"Many times patients who are coming in for an appointment are here because something has shown up on a prior screening and their anxiety and stress levels are high,” Cheryl Maize, manager of Mammography, and UBT co-lead says. “By streamlining our appointments and ensuring appointments run on time, we are hoping to allay some of that stress."
Initially, a 3-4 p.m. window was set, but as staff began to test the new process, they learned that starting the work that late in the afternoon was not ideal.
In some cases, they needed to return phone calls or required additional information, and they couldn't get everything done by the end of the day. The team pushed up the pre-work orders to a 1-2 p.m. time slot and the results improved.
In addition, the team implemented a "double-check" system at 4 p.m., so orders were again reviewed to make sure any outstanding items had arrived and everything was ready for the patient's appointment the following day.
The technologist reviewing the orders also would leave notes in the file if there was something the technologist who was seeing the patient needed to know.
Patient experience improved with the new process. Appointments were on time, and technologists were better prepared to work with their patients because the orders had been reviewed in advance.
"The implementation of the screening of orders 24 hours prior to patient arrival has allowed us to maintain our allotted appointment times and has made it easier to accommodate surprises such as late arrivals and walk-ins," Laura Wellnitz, technologist, and UBT labor co-lead says.
Eventually, a technologist was checking orders and printing out appropriate paperwork for diagnostic mammograms one day in advance of the appointments. This eliminated 10-20 minutes per appointment. As a result, most diagnostic appointments were completed in the scheduled 30 minutes, so subsequent appointments started on time.
Other staffers also preferred the new process. They decided to take turns verifying and reviewing orders, which provided a welcome break in the daily routine.
Mammography UBT implements case review process, reducing late appointments for patients.
When UBT co-leads at Sunnyside Medical Center took a closer look at their patient safety assistant usage, they agreed that reducing the number of hours was a top priority.
The patient safety assistants, also known as PSAs, were certified nursing assistants and provided a key service. They were assigned to sit in a room with a patient who had dementia, was confused or at risk of a fall. They could help if the patient tried to get out of bed, remove their IV lines, or became disoriented or restless.
And patients getting out of bed is not unusual.
Some try to get out of bed because they're bored and restless or they might need to use the bathroom. Restless patients often need a change of scenery, which might mean moving the patient to the nurses' station or to a public area. There might be a need to reduce noise by closing doors at shift change to keep it quiet.
During a five-month stretch, the Sunnyside nursing unit had used 1,550 hours on PSAs. At a cost of $62,000, they wanted to bring those hours down without adversely impacting patient care.
So staff members made it a priority to talk with the patients and families to learn about the patient's interests and hobbies and offer specific activities for patients to do during their stay.
"Using the activity boxes (which contain games, crafts, videos and more) with patients has been a great way to help patients stay busy, and it makes them feel better," according to UBT labor co-chair Glenda Vosberg, RN.
The goal was to reduce PSA usage by 10 percent in four months. Knowing this was going to be a full-team effort, a mandatory in-service was scheduled and the co-leads explained the situation to the rest of the team.
They trained staff on the options to using PSAs. They provided the team with baseline data and information on the financial impact of using PSAs, and had nurses assess patients to determine whether a PSA is needed.
The results were immediate.
In a month, hours dropped from 549 to 32 without any negative impact on patient safety. Within another two months, PSA usage fell to eight hours.
"Staff were given the data and information to help them understand the impact of the situation and get their feedback on alternative options to using a PSA," says Imelda Zapata, department manager and management co-lead.
The team also enlisted the assistance of Susan Woods, the clinical nurse consultant in the hospital.
One of Woods' responsibilities was to provide consultations with patients who were assigned PSAs. She worked with the patient, family and nurse to develop a plan that best fit the needs of the patient.
Kaiser Permanente also invested in several different equipment options, including low beds, which can be put all the way down to the floor, and bed and chair alarms that let nurses know if a patient tries to get up.
The combination of equipment, changes to the environment, and activities for patients allowed the team to keep their patients safe and improve their morale while decreasing the usage of PSAs.
"Often staff is concerned about patient safety when we talk about alternatives to assigning PSAs and may be reluctant to try other options. However, literature (and our local experience) shows that having a PSA in the room does not guarantee the patient won't fall or pull out their IV lines," Woods says. "We've found that reduction of PSA usage has not negatively impacted patient safety, just as the literature suggests."
Nursing unit takes a patient-centered approach to watching over patients and ends up saving over $60,000 in just a few months.