Issues in health care
There are many issues in health care on the rise but the one I will focus on for this reflection will be provider’s access. When patients are unable to schedule appointments because of provider access, it is hard for them to receive medical care, they are unable to build a trusting patient-provider relationship and may be unable to achieve overall wellness.
In the Endocrinology department at my facility, the patient access for a new consult is poor with their first available appointment not until October. For a patient who has diabetes or thyroid issues accessing care is critical for them to achieve optimal health outcomes and prevent disease state progression.
My facility is working to do is to improve patient access to all endocrinology clinics. The administration is working with the endocrinology providers and clinics to understand the challenges each is facing with the scheduling of new patient consults. They are working to develop strategies that will provide additional consult appointments.
The administration realizes that there is a need for more endocrinology providers based on the increase in the number of referrals they are receiving. They are analyzing the referral data to identify the areas of the city and surrounding counties that have a need for additional providers.
By the end of the year, we will be adding new doctors and advanced practitioners and expanding the footprint for endocrinology services by adding 4 additional clinics to meet patient needs.
Another area that would improve access is to understand provider schedules and ensured be schedule optimization. Physician leadership is looking at schedules to see where there are gaps and areas for improvement.
They are looking at several avenues to improve schedule optimization such as allowing internal medicine and family medicine clinics to direct schedule patients with certain diagnosis codes improving the timeliness of scheduling.
Those codes that are not allowed by direct scheduling will be sent to the centralized referral team for review and scheduling. Other areas of schedule optimization that is being reviewed and addressed is the patient no-show rates and looking at ways to decrease these percentages.
We have found that there is an increased number of patients that call last minute to cancel their appointments because they are running late for their appointment or have other conflicts. We are addressing this type of cancellation rate by converting these appointments to phone or virtual visits to allow the patient to keep their appointment.
We have found that many patients are willing to keep their appointment if they are able to complete them through phone or virtual visits.
The last area of improvement is the implementation of technology to allow different ways of communicating with patients to schedule their appointments. Our system has invested in many new tools to communicate with patients with the most recent being the ability to chat with patients to schedule appointments. We have found that many patients will not answer their phones but will communicate through text to schedule appointments.
The chat feature keeps the patient informed of their referral status and when the appointment is ready to be scheduled. When their appointment is ready for scheduling, the patient will have the opportunity to choose their preferred method to schedule with either a chat link or a link to call the office to schedule.
Meeting the patient’s overall needs is the ultimate goal for patient care and access. If the provider’s schedules are optimal for scheduling best practices patients will be able to receive treatment under any circumstances. When you ensure there are enough physicians to serve the high patient volume in endocrinology the system will be able to make sure that patients are receiving the healthcare they need and deserve.
Gemba Walk
On 6/23/2021 I went to observe The Adult Medical Speciality care coordinators for Endocrinology which is part of the Atrium Health Care organization located in Min Hill, NC. According to the Atrium Health website, Atrium Health is a nationally recognized leader in shaping health outcomes through innovative research, education, and compassionate patient care.
Atrium Health is an integrated, non-profit health system with nearly 70,000 teammates serving patients at 37 hospitals and more than 1,350 care locations. Atrium Health Care’s mission is to improve health, elevate hope and advance healing for all. Their vision is to be the first and best choice for care. (About Us, 2021; Bhnau PraKash, 2010)
The focus of my Gemba observation was endocrinology referrals. The department consists of 3 referral coordinators, and they were in process of replacing a vacant position. The goal of the Gemba visit was to identify areas of improvement in the current endocrinology referral processes.
To allow timely and efficient scheduling. I observed the referral coordinators at the Adult Medical Specialty Service Center which houses the centralized endocrinology coordinator team. During my observation, I observed the referral process from the beginning to the end. I sat with all the referral coordinators for the endocrinology departments.
The preliminary analysis of the observation of the referral process is that some referrals are not being processed in a timely or efficient manner. This stems from the need for additional endocrinology providers to care for the patients. It was noted that there is poor scheduling access for new consults. Additionally, it was noted that approximately 50% of the endocrinology referrals are sent to the clinical team for review and to determine scheduling guidelines.
Another observation is the need of opening new offices in the area where the need is for endocrinology providers. It was observed that patients that are in rural areas are unable to drive 1 to 1 ½ to come and see endocrinology for a consult. According to the JMCA, “This study finds a consistent relationship between measures of consult wait times and patient satisfaction.
Longer waits between initial request and either scheduling of the consult or the completion of the consult are associated with poorer satisfaction”. (Steven D. Pizer, PhD, 2017)The key takeaways from the Gemba walk are staffing, providers, and locations.
A long-term goal would be recruitment and the short-term would be additional staff cross-training, to implement new patient packets to be sent through the patient portal to cut down on copy paper and envelopes. Also, we are asking the leadership team to identify current diagnosis codes being reviewed and to work towards direct scheduling which will improve scheduling turnaround time. If the provider approve more referrals to be directly scheduled the patients will be able to be scheduled while they are at the primary care physician, which would cut down on missed phone calls.
Adding new technology like implementing chat patients will be able to click on a link and speak with a scheduler and schedule their appointment through chat. Another opportunity for the endocrinology department is to have flexible hours extended in the evening and open up on some Saturdays. This would give the patients who are not available Monday through Friday to schedule appointments on a Saturday. According to Bhanu Prakash, patient satisfaction will lead to patient loyalty (Bhnau PraKash, 2010)
In conclusion, the referral coordinators and the leadership was appreciative of the Gemba walk and look forward to implementing the suggestions from the Gemba experts.
References
About us. (2021, June 28). Atrium Health. Retrieved June 28, 2021, from https://atriumhealth.org/about-us
Bhnau PraKash. (2010, September 3). Patient satisfaction. PubMed Central (PMC). Retrieved June 28, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3047732/
Steven D. Pizer, PhD. (2017, March 10). Consult Coordination Affects Patient Experience. AJMC. Retrieved June 29, 2021, from https://www.ajmc.com/view/consult-coordination-impacts-patient-experience
