GRASS-ROOTS QI
GRASS-ROOTS QI
A peer group initiative at M.D. Anderson Cancer Center in Houston cut 40% from clinic wait times. It helped when medical director for quality improvement, Charles Levenback, MD and performance improvement specialist Angela Ravin-Anderson, MBA, MHA, persuaded physicians to post their patient visit times.
o Problem
(1) 43-minute appointment wait times and 106-minute arrival-to-departure cycles; (2) competing demands on physician time: teaching, research, patient care; (3) chinks in clinic-lab and clinic- radiology loops.
o Solutions
Staff role and workspace alignment: Each team’s physician, nurse, and patient service coordinator’s workstations are closer. This facilitates communication, enhances team spirit, and promotes parallel tasking. Nurse prepares/counsels patients as physician and coordinator care for others.
Physician attitude adjustment: Doctors agreed to (1) honor clinic hours of 8 a.m. to noon instead of holding conferences and expecting patients to wait; (2) book manageable number of appointments into four hours.
Shaping demand: Reduced patient follow-ups without compromising oncology care outcomes. Appointment reminders minimized no-shows.
Resistance management: (1) Showed physicians that improvement process was targeted to wait times, not patient contact. (2) Channeled doctors’ attention to self-controlled actions like punctuality rather than externals like glitches in turn-arounds for test results.
Posting arrival-to-departure cycles: Compos ites first, then individual profiles. In staff area first, then in patient areas. "Despite their worst fears," Levenback says, "nothing awful happened. The patients liked to watch our progress and staff helped each other reduce their individual cycles."
o results
Three months after all changes launched, wait times dropped from 40 minutes to 25; arrival-to- departure cycles dropped to 80 minutes (30%).
o Keys to success
Twelve months of "tinkering" prior to full roll-out: Re-positioned work areas, piloted measurements with individual teams. Maintaining gains through simple, daily measurements and regular staff discussions.
o Contact
Angela Ravin-Anderson, M.D. Anderson Cancer Center, Houston. Telephone: (713) 745-4432.
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