Value Grand Rounds - February 2017
The February 2017 Value Grand Rounds featured presenters from three Greenbelt project teams that sought to address a variety of process challenges at Dartmouth-Hitchcock (D-H). In kicking off the afternoon presentation, the Value Institute’s Director of Operational Excellence Sam Shields, MBA, LSSBB, CPHQ, noted the importance of applying the Continuous Improvement Maturity Model to manage and improve processes, which the Value Institute stresses to its Greenbelt students. “You want to make sure your processes are repeatable and well-defined because then they can be managed and optimized,” Shields said. “When you’re moving up the Continuous Improvement Maturity Curve, you’re improving performance and value to your customers and employees.”
“Optimize Efficiency of Secretarial Staffing in Medical Sub-Specialties Pulmonary, Rheumatology, Infectious Disease and Endocrinology”
The first presenter was Lauren Barry, associate practice manager of Rheumatology, Infectious Disease & International Health, Endocrinology, Pulmonary, Pulmonary Function Test (PFT) Lab, and Medical Intensive Care Unit. Her team included Caitlin Lowery, Lisa Gover, Chandra Lehman, Cindy Longhi, Alyssa Clemente and Erin Rice. Their Value Institute coaches were Alison Mumford and Joseph Caristi and their sponsor was Stacey Wilk. The team’s year-long project was entitled “Optimize Efficiency of Secretarial Staffing in Medical Sub-Specialties Pulmonary, Rheumatology, Infectious Disease and Endocrinology.” Barry and Caitlin Lowery supervise these four specialty areas, which are all co-located in 5C. Their goal was to improve and standardize the secretarial workflows to make it a better environment for staff and to help reduce costs.
The team created an affinity diagram to understand the work the secretarial staff does and noted the similarities they found between the four sections. They then did two weeks of robust data observation using Toggl, a free online tracking software program, and process mapping of referral processing and established patient scheduling. This enabled them to find some commonalities in workflow.
Lowery then presented on the root causes they found, which included a lack of updated training documents and staff’s lack of time to learn.
In their first pilot they found that two key tasks that needed to be added to the Daily Appointment Reminder (DAR):
- For departments that do a lot of joint scheduling, the Appointment Provider/Resource should be added. This gives exit secretaries the information they need to schedule the follow-up appointment with the correct provider.
- The “IMG unscheduled orders” and the “has orders” pages should be added for departments that place a lot of orders. Even though the order may not be for your department, it will flag the secretary to check for orders.
To ensure the process is in control, they created a series of reports in eD-H to help monitor performance:
- Report - tracks the number of patients that check out and the number of notes completed by a provider. This quickly shows them when they are not up to 100 percent.
- No Show Report – As long as the secretaries utilize the “no show” letter template, this shows them if they completed the “no show” letters for the week without searching through each chart.
- Updates & Standardization to the DAR report
“Obtaining Outside Records for New Patients to OB/GYN”
The second presenter was D-H Manchester Practice Manager Carly Gartside, whose talk was entitled “Obtaining Outside Records for New Patients to OB/GYN.” Her team members from D-H Manchester were Sue Wheeler, Kelley Langdon, Desi Bernard and Kim Rowe. The project resulted from the challenging process OB/GYN encountered in obtaining outside patient records. “The process lacked expectations and consistency, and was a consistent source of frustration for providers and front-end medical staff,” Gartside said.
The project’s goals were to:
- Reduce the number of times medical assistants found missing information during chart prep from 17 percent to less than five percent.
- Increase the number of times nurse’s found missing information during referral triage from five percent to greater than 50 percent.
- Increase the number of times external referrals come with all necessary information from 30 percent to 75 percent.
During the root cause analysis, a lack of knowledge about certain process areas was found to be part of the problem. Providers, nurses and medical assistants didn’t know how to find scanned documents and referring offices didn’t know what information specialists needed for appointments. To improve the process, providers agreed to a standard set of records for new incoming patients. The required information is now included in a referral triage cover page, and if any records are missing a letter is sent to the referring provider from eD-H. Gartside noted that once this process change was implemented, medical assistants didn’t find any missing medical records through the end of December 2016.
Among the lessons learned was that it was beneficial for all team members to attend Yellowbelt training, and that projects like these take time. Gartside noted that they started in July and wrapped the project up in February. “October was my mental date, but it came and went quickly,” she said.
“Outpatient Exit Notification”
Cheryl Rowe, who is the operations manager for Health Information Services in the Community Group Practices (CGP), presented the final Greenbelt project. Entitled “Outpatient Exit Notification,” her team members were Catherine Steinberg, Debra Morgan, Sara Pawl, Michele Sierra, Roxana Scarpino, Simone Gourde and Brenda Allen. Their Value Institute coaches were Otelah Perry and Danielle Potter and the project sponsor was Patricia Sorento.
Their project sought to find a better way to track their patients in order to know when they changed their Primary Care Provider and transferred out of Dartmouth-Hitchcock and the Community Group Practice. Not having this information tracked resulted in:
- Loss of revenue
- Decreased access to care
- Skewed panels
- Decreased patient satisfaction
Rowe said their goal was to create a process to notify Patient Orientation of a patient transfer. The team limited their scope to the CGP locations and to patients who completed an authorization.
They did two fishbone diagrams to determine the root cause and identified three areas that were in line with the scope of the project. “It all boiled down to communication,” Rowe said. Following a brainstorming session, which resulted in an idea form, and after working though the ideas and completing a Pick Chart, the team decided to focus on two areas:
- Creating a purpose for “transfer of care” in the release module
- Creating a smartphase that could be used to notify Patient Orientation for standardization
Monthly audits show that their new process resulted in 100 percent patient tracking success for the months of November and December.