When an oil boom led to rapid population growth in Lovington, NM, we experienced a 78 percent increase in patients at Nor-Lea Medical Clinic in a two-year period. We quickly found ourselves on a slippery slope, as patients sometimes waited 30 to 60 days just to book appointments, then spent another 20 to 45 minutes to get registered upon arrival, and finally waited another one to two hours in the lobby. As a result, patient, physician, and employee satisfaction scores started to plummet.
As the COO, I tried everything I could to improve the situation. I read books about patient flow and customer service. I became a Six Sigma Green Belt. We began the Baldrige Performance Excellence Program. Yet, nothing we tried made a dent in the problem.
Indeed, to successfully address the workflow challenges that were plaguing our not-for-profit, community-based healthcare organization, we needed to be able to work smarter, not just harder. Bottomline: We knew we needed to take a closer look at various data points to get a better handle on diagnosing workflow snags, and then implementing the improvements that would lead to better patient care.
To gather some of this intelligence, we used a real-time locating system (RTLS) to measure wait times, room utilization, provider time with patients, and other operational measures. This would provide us with a better picture of the root causes of some of our problems. With RTLS, everyone in the clinic wears location badges – patients, staff, and providers. A network of sensors installed in the ceiling constantly monitors the flow of people, keeping data on how long the patient is waiting and how much time they are spending with the medical assistant, the nurse, the physician, etc.
With such a system in place, we aimed to collect data to show where our workflow snags were and help us to identify the root causes of our workflow problems. Most importantly, we hoped to find the innovative fixes that could help our clinic serve more patients efficiently and effectively.
All aboard!
Before implementing the RTLS from Versus Technology, however, we needed to get staff on board. So, we approached them and asked if they would be willing to not only wear badges that monitor their workflow, but also help us leverage the intelligence garnered from this system to develop programs and design facilities that could substantially improve operations. By linking the use of the system to potential improvements in patients’, clinicians’, and other staff members’ day-to-day lives, we were able to get the buy-in needed.
Here are three ways the RTLS system helped us to both identify and address workflow challenges:
1. Keeping the wait top of mind. The RTLS system revealed that patient wait times were indeed too long – longer than we even realized. So, we used the Versus RTLS to display average wait times so all staff could see them in real time and provide the required service.
2. Analyzing providers’ differences. The system also offered data that enabled us to determine why some of our providers were able to see more patients per day than others, which ultimately increased wait times. It turned out there was a discrepancy in productivity between providers who worked in the back of the clinic versus those who worked near the front.
After reviewing the specifics, our service team decided to set up a second waiting area in the back, which immediately led to increased productivity for those physicians, as well as decreased wait times.
3. Addressing workflow snags. We have used the system to assess room turnover, patient registration, and exam room assignment times. The wealth of operational data available through the RTLS allowed us to identify several areas for process improvement, including:
- Changing staffing ratios to provide more staff to each provider at a lower cost;
- Changing the registration processes to reduce a large bottleneck; and
- Assigning two rooms to each provider instead of three, which allowed us to add four additional providers to the same space.
With these improvements, we have reduced days to receive an appointment from 30 to 60 days to five to seven days. Average wait times in the lobby have improved from two hours to 10 minutes. In addition, we have increased the number of patients seen per provider by 49 percent. And finally, we’ve improved physician satisfaction scores from 28 percent to 93 percent, employee satisfaction scores from 68 percent to 97 percent, and patient satisfaction scores from 14 percent to 80 percent.
Buy-in motivates change
Helping staff realize the true state of operations – instead of relying on competing and often false perceptions – enabled us to motivate the change we needed. The key to this success was making sure data was available to staff, and allowing them to lead the improvement efforts. Our providers in particular responded well to the statistically relevant, objective data provided by the RTLS.
By leveraging RTLS data, we have not only been able to diagnose workflow snags and implement changes to fix them, but also have enabled the daily operation of the clinic to become more efficient and less chaotic. And that directly correlates to the quality of care we’re now able to provide.
