A Patient Centered Approach for Coordinating

and Streamlining CareProcess Improvement Leadership Development Program

University of Missouri, ColumbiaFall 2010

Erica Schulte Karla McNew Tanya Aldridge Ward Childers Dr. Holly Ford, Physician Champion Advisor: Dr. Kristin Sohl Advisor: Dr. Tom Selva Advisor: Julie Brandt Keri Simon, Executive Sponsor

Team Members

Colette Nolin Ted Brandt Tami Clark Lacey Weddle

Additional Team Members

Currently women make an appointment for their annual exam and sometimes it gets linked to a mammogram if age/history appropriate.

These services may be at different locations and on different dates.

The vision proposed here would be that with a single contact with a concierge/scheduler, we could make several appointments to address multiple health care needs in the same visit.

If possible, the patient would circle back to the physician/nurse and receive any available results before they leave or a commitment to contact them with the rest of their information.

Goal

Survey 1Purpose: To see what is important to our patients

Method: Two week survey by Mammography and OBGYN Clinic Staff

University of MissouriWomen’s HospitalHere at University of Missouri Women’s Hospital, our number one goal is patient satisfaction. We are doing a brief survey to see what is important to you. It is important to us to give you what you want and need. Please take a few minutes to fill out this brief survey. We would really appreciate any feedback you could give us.

•If you could get all screening exams (Well Woman Exam with Pap Smear, Mammogram, Dexa Scan and Lab work) done in one day would you prefer this?very interested slightly interested slightly disinterested not interestedIf you are interested, circle which tests you would like to have done in the same day.

Well Woman Exam with Pap Smear Mammogram Dexa LabIf you are not interested, can you tell us why?__________________________________________________________________•Would you prefer calling one number to schedule all annual exams?very interested slightly interested slightly disinterested not interested•Would you be interested in pre-registering for your appointment or scheduling your annual exams on-line, if available?very interested slightly interested slightly disinterested not interested•Do you have any problems in scheduling your annual exams currently?very interested slightly interested slightly disinterested not interestedIf you did, please comment: ____________________________________________________________________________________________________________________________________________________________________________________________________

___________Please tell us what you do or don’t like about our current processes today:_______________________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________________________________________________________________

Thank you very much for participating in this survey.

Survey Results

Very Interested Slightly Interested Slightly Disinterested Not Interested0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

If you could get all screening exams done in one day would you prefer this?

Survey Results

Well Woman/Mamm/

Dexa/Lab

Well Woman/Mamm

Well Woman/Mamm/

Lab

Nothing Well Woman

Only

Mamm/Dexa

Well Woman/

Lab

Well Woman/Mamm/Dexa

Well Woman/Dexa/Lab

Mamm Only

Lab Only Dexa Only

0

0.2

0.4

0.6

0.8

1

If you are interested, circle which tests you would like to have done in the same day.

Survey Results

Very Interested Slightly Interested Slightly Disinterested Not Interested0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Would you prefer calling one number to schedule all annual exams?

Survey Results

Very Interested Slightly Interested Slightly Disinterested Not Interested0%

10%

20%

30%

40%

50%

60%

Would be interested in pre-registering for your appointment or scheduling you annual exams

on-line, if available?

Survey Results

Yes No0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Do you have any problems in scheduling your annual exams currently?

If you have had problems, please comment:Hours I work 8-5 Have to work around my work scheduleScheduling Conflicts Two times in five years, mamm and pap scheduled for same day but mamm

appointment was not in system Cancelled long set appointments (set appt Jan-bumped to July)Staff Knowledge Assistants in Doctor Office had me call wrong hospital to get mammogram.

They didn’t know that I should go to Regional for normal annual not Ellis. Which if for abnormal or problem mammogram. Confusion about where to go.

Inconvenience Not too bad. But my Doctor schedules mammogram here. My lab is at their

office, pap is their office. Sometimes little inconvenient. Not to bad. Just traveling north of Hallsville takes extra trips and time.

Just getting around to it

Survey Comments

We surveyed for two weeks and received 84 responses.

We had a 88% satisfaction rate with our beginning process.

Overall 85% of woman taking survey wanted one number to schedule both well woman exam and mammogram.

Overall Survey Results

People-Patient, physician and employee

satisfaction.

Service and Quality-Offering women an opportunity to schedule well woman and mammogram with only one phone call. Also, by offering a mammogram to all women, of age, we help remind woman who may put this off or may forget.

Finance and Growth-By offering each eligible woman a mammogram at their annual visit, we may increase volumes and revenue.

Why is this project important?

Women requiring screening mammogram Physicians Nurses Patient Service Representatives OB/GYN Department Radiology Department Registration Department Scheduling Department University Health Care System

Key Stakeholders

Beginning Process Flow

Fishbone Diagram

Pilot Process Flow

By March 30, 2011, we aim to increase patient satisfaction by 25% (increasing from 88% to 91%) by allowing patients to call the OB/GYN Clinic to schedule both well woman exams and screening mammograms for the same date of service.

Satisfaction is measured by the results from the survey we created.

Aim Statement

Developed a process for patients calling the OB/GYN Clinic to be able to schedule their Well Woman Exam and their Mammogram at same time.

To implement we met with Training Department Manager, Tami Clark, to get training and IT arrangements set up. We also met with Colette Nolin, Assistant Manager Clinical Registration Services, to make sure she was aware of our plans and tentative go-live date.

Lacey Weddle from the training department trained all OB/GYN PSR’s on January 21, 2011. Staff were split into two groups each attending a four hour class.

Tami Clark and Lacey Weddle both visited the clinic on Monday January 24, 2011 to insure all individuals had the correct Cerner access and set up. They also confirmed each individual’s access and gave go ahead for pilot.

Began Pilot on Tuesday January 25, 2011.

Intervention

Call all patients to review survey within 2-3 business days to determine the level of satisfaction with our new scheduling process.

Measurement

1. Please rate the convenience of scheduling your Well Woman

Exam and Mammogram with Missouri OB/GYN Associates.

1. Poor 2. Fair 3. Good 4.Excellent

2. Where you able to get all appointments scheduled with one

phone call?

3. Did you experience any problems trying to schedule your Well

Woman Exam and Mammogram?

Follow Up Survey

The vision of this team, is that this process will allow WCH to be the lead mammography site for providing well woman mammograms in the University System.

Screening mammograms are the first pilot, but we envision scheduling other exams such as diagnostic mammograms and dexa scans at Missouri OB/GYN Associates.

We believe that in only a short period of time, patients may not even realize that there was a different procedure prior to our current one.

We also believe we will become more patient centered and our patients will have a more satisfying experience.

This project has led to an increase in staff satisfaction at Missouri OB/GYN Associates. Staff have enjoyed the removal of “the middle man,” and have taken on the responsibility with open arms. They enjoy being able to offer the patient something more and feel like they are part of a huge step forward in customer service.

Summary

Questions