At most hospitals, under normal circumstances, any clinic would welcome an increase in its number of physicians. But when the clinic’s facilities don’t grow to match, that progress can be too much of a good thing.
Such was the case in the Johns Hopkins Department of Otolaryngology–Head and Neck Surgery. During the past 15 years, even as the number of physicians in its outpatient clinic doubled, available clinic space remained the same, putting an increased strain on the system. Patient waits gradually grew longer, more patients were arriving without a necessary referral, and physicians became frustrated with the delays that often ensued when patients couldn’t be placed quickly in exam rooms.
“A lot of things needed realignment,” says otolaryngologist Sandra Lin, who was asked to lead the effort to improve efficiency. “We knew we weren’t going to get any more space, so we asked how we could cut down on wait times and confusion.”
With assistance from Julie Reh and Deann Gavney, members of Hopkins’ Center for Innovation in Quality Patient Care, Lin set out to dissect exactly where the system kinks were occurring. Using what are called LEAN principles—methods originally designed to streamline manufacturing processes—Lin and her group identified areas that had become prone to bottlenecks. For instance, Lin says, when patients arrived without referrals, it caused back-ups at the registration desk. Or delays would begin while patients awaited their turn at the clinic’s sole vital-signs station.
“Our primary goal became to decrease the time between a patient’s arrival and seeing a physician,” Lin explains. “We worked with everyone who was important to this, from the people who take phone calls, to nurses, physicians and administrators, because we realized that if you change one thing, you affect other things as well.”
Among other things, the group eliminated the vitals station in favor of checking patients’ stats right in the exam rooms. They designated one person to help patients who lacked referrals. They made schedule changes so that patient service coordinators were present for peak hours, and they threw out paperwork that they deemed repetitive. The process, Lin says, took only about six months—which is comparable to the speed of light in the time zone of an academic medical center.
And the results are impressive: Wait times decreased by 12 percent, the amount of time patients spent with physicians increased by 21 percent, and the number of patients seen by a provider within 10 minutes of their appointment time nearly tripled.
“We have about 30,000 patient visits every year,” Lin says. “By going through the clinic with a fine-tooth comb, we were able to make the changes we needed to so that we can give our patients a better experience.”