do your patients ever get lost

WCBF 9th Annual Lean, Six Sigma and Business Improvement in Healthcare Summit

Do Your Patients Ever Get

In the Patient Access Process?

May 12, 2010

WCBF 9th Annual Lean, Six Sigma and Business Improvement in Healthcare Summit

WCBF 9th Annual Lean, Six Sigma and Business Improvement in Healthcare Summit

Piedmont Newnan Hospital• Newnan, Georgia (Suburb of Atlanta)

• 143-bed acute care hospital

• Owned by Piedmont Healthcare

• Exciting new state-of-the-art facility underway

• Patient Access Department

� Centralized scheduling

� Preregistration

� Pre-certifications for MD offices

� 230 physicians

• 1,268 scheduled radiology procedures per month

� Approximately 250 CTs per month

WCBF 9th Annual Lean, Six Sigma and Business Improvement in Healthcare Summit

Piedmont Outpatient Center selected as one of the "Top Women's Imaging Centers to Watch in 2010" by "Imaging Technology News"!

WCBF 9th Annual Lean, Six Sigma and Business Improvement in Healthcare Summit

Team Focus

WCBF 9th Annual Lean, Six Sigma and Business Improvement in Healthcare Summit

Team Members

Physician Office Managers, Physician Outreach, CFO, Scheduler, Preregistrar, Precertification, Director of Lab, VP Quality, Director of Radiology, Patient Access Coordinator, Director Business Office, Registrar, Radiology Tech, Information Services, Engineering

WCBF 9th Annual Lean, Six Sigma and Business Improvement in Healthcare Summit

Great at medicine.Not so great at access…

WCBF 9th Annual Lean, Six Sigma and Business Improvement in Healthcare Summit

Rapid Process Improvement (RPI)

• Establish Team with representatives from all areas/shifts

• Balance the team between supporters of the process change and “na sayers”

• Include decision makers on the team and establish executive sponsors

• Dedicated staff for 4 days• 2-hour training on LEAN thinking

“Win Small, Win Often, Win Early”

WCBF 9th Annual Lean, Six Sigma and Business Improvement in Healthcare Summit

Project Scope and Goals

Project Scope:• Streamline the process for access to outpatient radiology

procedures to minimize non-value added steps

• Maximize value for the patient and the physicians office

Goals:• Improve patient, physicians’ office staff and employee satisfaction

• Reduce the number of patients who are rescheduled or delayed dueto incomplete paperwork

WCBF 9th Annual Lean, Six Sigma and Business Improvement in Healthcare Summit

An organized, universally agreed upon approach.

WCBF 9th Annual Lean, Six Sigma and Business Improvement in Healthcare Summit

Value Stream Map -Before Process

WCBF 9th Annual Lean, Six Sigma and Business Improvement in Healthcare Summit

Top 5 Observations“Go to the Gemba”

• No visibility of where patients are in the process.– Lab and Radiology waiting room is a “black hole”

• Re-faxing / Multiple phone calls to physician offices.• Lack of communication between departments. For

example, orders not visible to radiology day before to check orders complete.

• Why are patients getting back to radiology with out order / prep / lab or even to hospital?

• Excessive movement by the patient (up and down).

WCBF 9th Annual Lean, Six Sigma and Business Improvement in Healthcare Summit

New Process

WCBF 9th Annual Lean, Six Sigma and Business Improvement in Healthcare Summit

Process – Patient Arrives

WCBF 9th Annual Lean, Six Sigma and Business Improvement in Healthcare Summit

Key Process ChangesScheduling:• Scanning orders once received – NO MORE BATCHING.• 48 Hour No Exception Rule.

(no order, no clinicals, no labs, no procedure)• Standardized process for scheduling to provide prep

instructions.• Pre-reg to 80% for outpatient radiology procedure to

include collection.• Defined secure and non-secure utilizing checklist.

WCBF 9th Annual Lean, Six Sigma and Business Improvement in Healthcare Summit

Key Process ChangesRegistration• New process for pre-registered patients (one stop shop).

• New layout of registration area.• Print pre-registered packets the night before.• Patient Tracker implemented for Registration,

Radiology, and Lab.

Communication to Physician Offices:• CT Ordering guide provided to physician offices.• Modified outpatient order form.

WCBF 9th Annual Lean, Six Sigma and Business Improvement in Healthcare Summit

Patient’s Name: _____________________________ Date of Appointment: ______________________ Time: ___________ Please arrive 15 minutes prior to your scheduled appointment time for registration. EXAM PREPARATION: *Please stop by the Radiology Department’s Front Desk to pick up two bottles of Redi-Cat at least one day before your scheduled appointment, if not supplied by your doctor’s office. * If your appointment is scheduled before 10:00 a.m., please follow these instructions: □ Prep for Abdomen or Abdomen/Pelvis CT scan prior to 10 a.m.

• At 10 p.m. the evening before the exam, drink one (1) bottle of oral CT contrast. Do not eat or drink anything other than water after midnight.

• On the morning of the exam, do not eat or drink anything other than the oral CT contrast. However, you may have water.

Thirty (30) minutes before the exam, drink the second bottle of oral CT contrast. * If your appointment is scheduled after 10:00 a.m., please follow these instructions: □ Prep for Abdomen or Abdomen/Pelvis CT Scan after 10 a.m.

• Drink one (1) bottle of oral CT contrast three (3) hours prior to the exam time. • Nothing to eat or drink other than water after the first bottle of oral CT contrast. Thirty (30) minutes before the exam, drink the second bottle of oral CT contrast.

If you have any questions regarding your test or prep instructions, please feel free to call the Radiology Department at (770) 304-4220. Rev. 6/18/09/DPH

WCBF 9th Annual Lean, Six Sigma and Business Improvement in Healthcare Summit

WCBF 9th Annual Lean, Six Sigma and Business Improvement in Healthcare Summit

Checklist for Pre-Reg

� Reminder of appointment & arrival time� Prep Instructions� Labs complete and posted to Meditech� Order� Pre-Cert� Money Collected

WCBF 9th Annual Lean, Six Sigma and Business Improvement in Healthcare Summit

WCBF 9th Annual Lean, Six Sigma and Business Improvement in Healthcare Summit

WCBF 9th Annual Lean, Six Sigma and Business Improvement in Healthcare Summit

75.0%

80.0%

85.0%

90.0%

95.0%

100.0%

Jan - Mar 09 Apr - June 09 July - Sept 09 Oct - Dec 09 Jan - March 10

Outpatient Satisfaction - Overall Mean

Ease of Registration Waiting Time in Registration Standard Registration

WCBF 9th Annual Lean, Six Sigma and Business Improvement in Healthcare Summit

0.0%

15.0%

30.0%

45.0%

60.0%

75.0%

90.0%

105.0%

Jan - Mar 09 Apr-Jun 09 Jul - Sept 09 Oct - Dec 09 Jan - Mar 10

Outpatient Satisfaction Percentile Rank

Ease of Registration Waiting Time in Registration Standard Registration

WCBF 9th Annual Lean, Six Sigma and Business Improvement in Healthcare Summit

30.0%35.0%40.0%45.0%50.0%55.0%60.0%65.0%70.0%75.0%80.0%85.0%

Jan - Mar 09 Apr - Jun 09 Jul - Sept 09 Oct - Dec 09 Jan - Mar 10

Outpatient Satisfaction - % Very Good

Ease of Registration Waiting Time in Registration Standard Registration

WCBF 9th Annual Lean, Six Sigma and Business Improvement in Healthcare Summit

20%

30%

40%

50%

60%

70%

80%

90%

2nd Qtr 2009 3rd Qtr 2009 4th Qtr 2009 Jan/Feb 2010

Pre-Registration

Pre-registration

WCBF 9th Annual Lean, Six Sigma and Business Improvement in Healthcare Summit

“Code Skelton”

WCBF 9th Annual Lean, Six Sigma and Business Improvement in Healthcare Summit

Thank You!

Anna IvoryVP, Organizational QualityPiedmont Newnan Hospital

Email: Anna.Ivory@piedmontnewnan.orgPhone: (770) 304- 4081