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Thanks to a continuous quality improvement (CQI) initiative, Marianjoy Rehabilitation Hospital and Clinics in Wheaton, IL, cut more than 150 steps off what had been a 187-step admissions process. Referral sources now use an 800 number to reach a centralized department composed of a team of outreach admission representatives, admission staff representatives, and nurse liaisons.
"About 18 months ago, we became aware of some customer dissatisfaction," says Joan Bisterfeldt, RRA, administrative director of information services. "The concerns were that the admission process was very time-consuming and very fragmented."
In addition to inpatient rehabilitation, day rehabilitation, and outpatient services, Marianjoy offers InteRehabSM, an 85-bed subacute care program that operates in four, freestanding skilled nursing facilities, strategically located in the Chicago metropolitan area.
"We now have the ability to take referrals directly from patients and/or families," Bisterfeldt says. "Before, if a family member asked us [for a direct admission] we referred them to their family physician who then had to call Marianjoy.
"Outreach admission representatives and nurse liaisons now have the ability to collect medical and financial information while at the referring hospitals," Bisterfeldt says. Also, referring hospitals and payers now have a single point of contact, rather than having to make several calls to five or six departments.
"We also can make a faster commitment to admit for specific payers, and we can accommodate their special information requests," she says.
Because the old admission process also crossed several departmental lines, Bisterfeldt knew that any re-engineering would have to be interdisciplinary in order to succeed. Therefore, the CQI team included representatives from the following departments:
• subacute program;
• patient billing;
• information services.
"The first thing we labored over was to flowchart the admission process," Bisterfeldt says. "It was such a revelation we couldn’t flowchart it without becoming confused ourselves. We immediately saw all the potential for delays and how one step affected the next step. It was absolutely obvious we needed an entirely new system."
The team proposed developing an admission system that would streamline the process both externally for their customers and internally for the staff. "Aside from needing one single point of contact, we also saw how we could reduce duplication of work in several of our processes," Bisterfeldt says. "We wanted a system streamlined enough so that if we received multiple referrals simultaneously, the admissions process would not be deterred."
For example, previously, referrals were not being entered on-line as they were received but rather listed on a paper form and then transcribed. "We discovered we did not have real time access [to the hospital information system] so two different departments could not work simultaneously on an admission," Bisterfeldt says.
The team also set out to design a system with "built-in accountability," says Bisterfeldt. "Under the old system, each person only had a little piece of the admissions process and then they were out of the picture," she explains. "But we wanted a system that called for total responsibility. We wanted staff to feel that this was a mission for them to accomplish."
The team then located a space for the new department with a minimum of effort and expense because there were no major renovations involved.
Staffing and training the department was another issue. In addition to expanding hours until 6 p.m. on the weekdays and from 10 a.m. to 2 p.m. on Saturdays, all admission employees were cross-trained to handle all functions from referral to the start of the evaluation, Bisterfeldt says.
Staff underwent a four-week training program, including a mid-term, finals, and proficiency exam that covered the following topics:
• financial verification;
• available programs and services;
• using the information system;
• admission procedures;
They also took field trips to Marianjoy sites and role-played various marketing aspects. "We wanted them to know how to talk to potential payers," Bisterfeldt says.
Five members of the admission staff work on site receiving basic patient information, processing financial verifications, and pre-certifications. Six outreach admission representatives and nurse liaisons work in the field to collect admission and medical information from referring hospitals, nursing homes, and physicians’ offices. These staff also provide counsel to families and perform marketing functions such as conducting seminars and educational programs.
As a result of this process improvement, admissions have increased specifically in Marianjoy’s InteRehab program, which recently set a new record for census during a one-week period.
The efficiency of the process also has improved dramatically. An outreach admission representative related an incident in which she received a call on her car phone telling her to see a patient at a nearby hospital. She saw the patient, completed the evaluation, had medical and financial information approved, and had a bed available in less than one hour.
"Our overall goal from the start was to improve customer satisfaction and with results such as these, we feel we are headed in the right direction," says Bisterfeldt.