Patient flow QI program garners Codman Award
Patient flow QI program garners Codman Award
Health system turned its scores around in a year
Trinity Regional Health System of Rock Island, IL, had a problem. For ambulatory care, patient satisfaction scores in fall 1997 were barely above 50%. As the system got ready to move outpatient care into a dedicated facility, Marcia Rose, MBA, CPHQ, administrative director for quality management and pharmacy services, and Bonnie Leinart, RN, MSN, chief operating officer, knew they had to do something.
"There were long wait times," says Leinart. "We were not doing well with outpatients. And since we were closing the old building, we spent a lot of time identifying areas to focus on."
Improving patient flow
The resulting effort improved patient flow, simplified patient registration, eased parking and lost-visitor/-patient problems, and took on post-surgical charting problems. As a result of the Trinity team’s efforts, within a year, ambulatory care patients were ranking the system as high as the 99th percentile, and never lower than 95%. Those efforts won the system an Ernest A. Codman Award from the Joint Commission on Accreditation of Healthcare Organizations in November.
Leinart says the team that was put together to improve patient satisfaction included people from across the organization. "The key teams that worked on things were the diagnostic delivery departments like X-ray. They worked on creating as seamless a visit as possible. But everyone was involved in this process."
They started with an organizationwide retreat that included architects, engineers, nurses, chaplains, and physicians. Part of the program, Leinart explains, was to do role-playing of what would happen if a patient came into the system for something. "If I came for a mammogram and EKG, and some blood work, I had to walk more than a mile. I had to get in my car and go to another building. And the departments didn’t communicate well with each other."
Itinerary follows patient
A routing slip, called an itinerary, goes with the patient from department to department. (See sample itinerary, p. 18.) Another way to ease the process was to have some departments start doing more tests than they used to do, and do them in the new facility to keep those diagnostic testing facilities close together.
The lab and EKG tests are now done in the same place. Travel time is minimized, and wait times have been reduced from a high of 45 minutes to almost instantaneous service when a patient presents at the testing site.
Rose says patients also benefited from new registration procedures. Prior to moving to the new building, there was always the risk that a scheduled outpatient would have to be bumped for an acute care patient who came into the facility. "The outpatient is the priority now," says Rose.
Another situation patients identified as irritating was that multiple staff often asked for the same information. "If a patient had a cataract surgery on one eye, when he came to do the other he had to provide the same information," says Leinart. The computer staff at Trinity developed a computerized documentation process that is fairly unique to outpatient settings. It includes laptops with antennae that pick up information immediately as it is typed in, Leinart explains. They are on carts that can be wheeled from place to place.
"Once you give the health history now, it’s there in the computer," she says. "The only written documentation is the OR record the anesthesiologist uses. Anyone can pull up that chart live and access the information. Vitals are live in the computer when they are taken, and the documentation is there, right next to the patient. The quality of the documentation also improved."
The results of these efforts were not only improved patient satisfaction, but more legible documentation, increased compliance with charting, a decrease in the time spent preparing charts and looking for missing paperwork, and the ability to do continuous quality improvement tracking.
Effort cited by JCAHO
This effort in particular, says Leinart, was cited by the Joint Commission as one of the highlights of the whole patient satisfaction improvement program.
Trinity also decided that patients should have more help when they entered the outpatient facility, says Rose. It instituted a greeter and valet service. Greeters are on site from 5:30 a.m. until 6 p.m., and the valet service is available from 6:30 a.m. to 5 p.m.
"We have committed dollars to that. The greeters are at the front, checking on our patients and will walk them to the area where they need to be," she explains. There is also an "empowerment" fund that any employee can use to fulfill simple needs for patients. "If someone is waiting for a patient for a long time, we will give them a lunch voucher," Rose says. "If someone forgets a hairbrush, [we can provide one], or if someone is having a really hard time, we can get them flowers. The fund is for use at the discretion of the employees without approval."
Surprisingly, there has been no abuse of that fund. Leinart says one department has a lot of indigent patients, and the money was being used for prescriptions. "We have to watch that kind of use, but for the one-time things like buying a teddy bear for a scared kid, it’s a really positive thing."
The results of these efforts included an increase in the patient satisfaction scores for wayfinding from a low of 28% in the fourth quarter of 1997 to 98% a year later. The parking scores improved from 38% at the end of 1996 to 72% by the fall of 1998.
Registration was improved by more than doubling registration staff, decreasing the turnover in the positions, and increasing the amount of pre-registration among ambulatory patients. Training registration staff and increasing their pay have helped to decrease the turnover rate from 33% in 1997 to 20% in 1998. And pre-registration is now nearly 90%, accomplished in great part because Trinity extended pre-registration hours into the evening.
Great, but can it get better?
Although the results of these combined efforts have been astounding enough to gain the accolades of the Joint Commission, all is not complete. The testing department group continues to meet monthly or every other month, says Leinart. "They found that some things that they did initially stopped working. We found you can never overcommunicate, and communication can still break down." Some things the group tried to improve patient flow didn’t work. For instance, they hoped walkie-talkies would improve communication among different testing areas. But they were annoying to patients.
There is a continuing feeling that the better the system gets, the higher the bar gets. "That’s the whole thing about quality improvement," says Leinart. "You are really never done." The organization has a goal of an average patient satisfaction score of 95% throughout the system, and that goal is woven into staff evaluations so that everyone knows it is important, she says.
Its success has been predicated on support throughout the organization, including from the board and the chairman. "Our chairman has been instrumental," Leinart says. "She was the one who encouraged us to apply for the Codman. She knew we had something special enough to share with others."
Rose also thinks the whole PI program Trinity undertook worked because they made sure that everyone who should be on individual improvement teams was. "We took the time to evaluate everyone who was involved in the process."
One more thing to note: Not only did Trinity improve its patient satisfaction, it did so at a time when patient volume increased by 19% and patient revenues rose by 12%.
"Here we were, expending resources to achieve better performance while at the same time our market share increased," says Leinart.
"We can now treat more people in a timely manner. Our throughputs are improved. We are more efficient. That just shows that these things are all woven together — increasing patient satisfaction, increasing efficiency, and increasing market share," she says.
[For more information, contact:
• Marcia Rose, MBA, CPHQ, Administrative Director for Quality Management and Pharmacy Services, and Bonnie Leinart, RN, MSN, Chief Operating Officer, Trinity Regional Health System, Rock Island, IL. Telephone: (309) 779-2979.]
Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.