At Virginia Mason Hospital and Seattle Medical Center, patient access leaders recently did a “kaizen” project involving registration.
Kaizen is a system of continuous quality improvement. Staff members who do the work evaluate and change processes to make work flow more efficiently and improve the overall patient experience.
“We have an average of over 7,000 appointments arriving per week in two different pavilions,” says Darryl Perry, supervisor of patient financial services. Patients are classified in these ways:
Frequent appointment: For this group of patients who come in several times a month, cycle times (the amount of time it takes to check in a patient for his or her appointment) actually increased from 50 to 70 seconds from 30 to 50 seconds. This increase is because staff identified the need to verify these patients’ information.
“We recently discovered that if you come in to see us on the third of the month, we really need to make sure that when you come to see us on the 20th that nothing has changed during that time,” says Perry.
In some cases, patients’ insurance or demographic information changes between two visits occurring over a short period of time. “We need to capture and update those changes. Otherwise, we will pass along ‘defects’ into our billing system,” says Perry. “We can no longer assume everything’s the same.”
Established patients, who come in once every few months or annually: Cycle times for this group were cut from 3-5 minutes to approximately three minutes.
New patients: Cycle times previously averaged eight minutes for this group and have been cut to five minutes.
Here are two things that patient access learned from the kaizen quality improvement project:
A surprising number of people didn’t need to be waiting in the registration line.
First, patient access determined that lines consistently formed during late morning and early afternoon. During these high-volume times, or if a line forms at another time of day, an employee goes through the line and says to each person, “Good morning/Good afternoon. Are you here to be checked in for your medical appointment?”
About two or three of every 10 patients aren’t waiting to be registered and can be re-directed by staff. Many need directions to a patient’s room, the cafeteria, or the laboratory. Others just need their parking ticket stamped. “We always knew that there were people in the line that didn’t have to be there. We don’t want anyone unnecessarily wasting time waiting,” says Perry.
Many patients asked for help with way finding after they were checked in, which added to registration delays.
Registrars often spent several minutes giving patients detailed directions to their appointments. Jennifer Bradley, director of patient relations, says, “We are implementing a program so volunteers will take them instead. Our goal is that there is always somebody there to help direct the patient.”
The registration process is continuously evaluated to reduce delays. Recently, patient access leaders from a Florida hospital were invited to Virginia Mason for a five-day Rapid Process Improvement Workshop, which is an essential tool in the Virginia Mason Production System, the organization’s management methodology. Virginia Mason’s patient access leaders asked for their suggestions to stop registration delays.
Perry says, “We said, ‘Tell us what we are missing. We want your ideas. You are going to see things that we miss every day.’” The group suggested adding overhead lights to indicate which registrar was free, similar to the process used at some banks and retail stores. They also thought a lobby redesign would improve patient flow.
“Those would have required a massive capital upgrade. But even though we are not able to do those things right now, we still want those ideas,” says Perry. “We may be able to use them in the future.”
