Appointment time: Know where your patient is?

No? Maybe you need a way-assisting program

Did you ever wonder if perhaps hospital architects and designers think there is a rule that health care facilities must be a rabbit warren of look-alike hallways and waiting rooms? Maybe they believe patients enjoy getting lost as a way to bring interest to their day? Or new staff members want to spend the first days of work with a permanently perplexed look on their faces?

Of course they don’t, but the results of new (and old) building efforts often wind up looking like mazes. One facility decided to buck the trend. When The University of Texas M.D. Anderson Cancer Center in Houston got ready to bring the Alkek Hospital on-line last year, there was a real push to help staff and patients find their way around both the new facility and the rest of the 3 million square feet of space in the center.

"With that much space, there is a constant need to help patients get where they need to be," says Bill Walker, MS, senior planner at M.D. Anderson. That need led to a program called "way-assisting," that includes dedicated phone lines and a focus on customer service that runs from housekeeping staff to physicians. "From orientation onward, we drill into staff that if you see someone who looks lost, you ask them if you can help."

The existing facilities weren’t as bad as some are, says Rick Murray, director of the Academy for Performance Improvement at the center. "We have two separate hallways, with patients walking one area and staff another. Every zone is color-coded. If you aren’t colorblind, and you use the correct elevator bank, it’s not impossible to get to a location."

But with so much space, patients often would say they feel like they have to walk forever to get from one place to another, Walker says. "You may walk the equivalent of several city blocks to get from one area to another. And, at a cancer center, the patients are mostly older and tend to be weak, so we have to try to make sure they aren’t a block off when they figure out they are lost."

Murray says the program they developed is part proactive — to help patients and staff at a time when 250,000 square feet of new space was being added — and part reactive to the complaints of staff and patients who often found themselves lost. "One of the vice presidents was listening to me talk about the program for the new building, and he said, But we still have issues in the old buildings,’" Murray recalls. "That’s when we really decided to create a way-assisting program that would give employees the confidence to help people."

The first part of the system is a telephone line. Signs are posted everywhere (see sample sign, left) directing any patient or staff member to phone a specific number for way-finding assistance. There are some 100,000 patients per year at M.D. Anderson, 10% of whom speak no English.

"A lot of people you walk up to won’t understand you if you ask if you can help," Murray says. That meant setting up a system that would not only give directions, but could also provide access to translators. "If I stand in the hall, I can get a translator on the phone almost instantly. The patient can tell the translator where he or she needs to go, then tell me how to take them there."

Designed for users — all of them

Patients aren’t the only people the system was designed for. Walker notes that the first call into the new help number was from an employee.

The phone system was put together with the assistance of the information systems department, says Walker. "We had developed an idea of a welcome center at entrances where patients could get information, but also where general telephone queries could come." Those who answered the calls had to use maps that were "reasonable for anyone" to use.

Walker, Murray, and their team tested the system before it went live. "We went out to different locations and called the number to ask for directions," says Murray.

One positive outcome of the testing was the identification of some security needs. "We decided that if a person asks to see a specific physician, we will direct them to the nearest reception area," explains Murray, "not the office. And if a physician has a threat against them, the computer system directs the person answering the phone to send an escort to them. Then they call security to escort the person to their appointment."

The second part of the system is perhaps the most important: training staff in how to provide help to patients. The goal is to get staff to automatically guide patients to where they need to be, but have the phone system as a backup.

"I was a lifeguard, and I went through all the classes, but when you go in for rescues, no one ever grabs you according to Red Cross rescue holds," says Murray. "But the classes gave me the confidence to rescue. That’s the kind of confidence we wanted to instill in our staff."

"The goal is for the phone to be unnecessary to patients because our staff is so service-oriented," adds Walker.

Once the system was in place, Walker says, they created a video, using employees for actors, and a University of Texas video crew. This training video cost a whopping $1,500. A similar tape for another program using actors cost about $25,000. They then held train-the-trainer sessions and put together a package of scripts, the video, and discussion questions and exercises for each department.

"We rolled it out as part of the training for the new facility, and that made it very effective because everyone wanted to learn about Alkek," says Walker.

The process must have worked, says Murray. "We’ve had some calls, but not as many as we thought we would have. Rather, we see more patients being escorted. You see that service orientation coming through. Even the physicians escort patients."

A recent waiting room study provided some proof that the system is working. Without prompting, a number of respondents said one of the things that most satisfied them during their experience at M.D. Anderson was how courteous the staff is. "We had more than one comment where patients said they just had to look lost to get attention," says Murray. "It’s not a broad survey, but it is some data."

Although there has been a dearth of negative comments, Murray says not everything about the program ran smoothly. "There was some confusion about how to number the phones. We made the mistake of asking people how they thought we should do it. We should have just chosen it ourselves." The hospital has a color-floor-room numbering system, and the phones were going to be numbered along those lines. "But then we asked for input. We wouldn’t do that again."

Murray, who isn’t from Texas, knows that there is a custom of hospitality in the state that was already present at M.D. Anderson. "Even though Houston is the fourth-largest city in the country, this is a friendly place," he says. "But this program formally communicated our expectations about assisting patients to our staff. We told them that we expect them to take people to their appointments. We expect them to ask if they can help, and then we showed them how to do it. This took down a barrier. This is an expectation now, not just a custom."

Walker says that becomes increasingly important in a large facility like the Texas Medical Center which has the second-highest density of cars after Manhattan and sees some 200,000 people daily. "We have 20 or 30 member institutions in a small area. Our patients often get lost just trying to find us. M.D. Anderson Boulevard doesn’t even connect to the cancer center — sometimes they arrive here frustrated. Then there is the whole parking situation. Our goal has to be to make sure they don’t get lost again, that we welcome them, [and] that we reduce their stress level as much as possible."

The emphasis on providing customer care to patients has come from the top down. Once a month, the cancer facility’s managers pull a 7 a.m. to 9 a.m. shift in the clinic lobby, saying hello and greeting patients, asking if they can help. "I really think that this is working," says Murray. "Every patient who walks in the door here has heard they have cancer. And every patient who walks through the door here has decided to fight. So we think we owe them something special. And I think that if it didn’t say UT’ on the front of the building, you wouldn’t believe this was a state anything. We pride ourselves on making ourselves innovative and customer-friendly, in making this an upbeat and hopeful place."