Date: May 3, 2010
How one clinic found ways to speed up their system.
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, the available clinic space remained the same, putting an increased strain on the system. Over that time span, patient waits gradually grew longer, an increasing number of patients arrived without a necessary referral, and physicians became frustrated with the delays that often erupted when patients couldn’t be placed quickly in exam rooms.
“We realized there were a lot of things that needed realignment,” says otolaryngologist Sandra Lin, who was asked to lead an effort to improve clinical efficiency in the department. “From the start we knew we weren’t going to get any more space. So we asked how we could do all of our procedures and move patients through the clinic more efficiently, thereby cutting down on wait times and confusion.”
With assistance from members of Hopkins’ Center for Innovation in Quality Patient Care Julie Reh and Deann Gavney, Lin set out to dissect exactly where the kinks in the system were occurring.
Using what are called LEAN principles—methods originally designed and applied in the streamlining of manufacturing processes—Lin and her group identified areas that had become prone to bottlenecks.
For instance, Lin says, many patients arrived with no referrals, causing a back-up at the registration desk while they tried to right the situation. Or delays would begin while patients waited to have their stats taken at the clinic’s sole vitals station before they could be taken to an exam room.
“Our primary goal became to decrease the amount of time between a patient’s arrival and the moment they see a physician,” Lin explains. “We worked with all of the people who were important to this, from the people who take phone calls, to nurses, to physicians, billing and administrators. We wanted to take a comprehensive approach, because we realized that if you change one thing, you ultimately affect other things as well. We wanted to avoid the kind of snafus that had put us in this position in the first place by looking at how changes can impact the big picture.”
So they got to work. Among other things, the group eliminated the vitals station in favor of checking patients’ stats right in the exam rooms, designated one person to deal with patients who lacked referrals, made schedule changes so that patient service coordinators were present for peak hours, and 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, she says, have been impressive.
Patient wait times decreased by 12 percent, while the amount of face time patients spent with physicians increased by 21 percent. Meanwhile, the number of patients seen by a provider within 10 minutes of their scheduled appointment time nearly tripled.
“We have about 30,000 patient visits every year,” Lin says. “We have a lot of people who want to see our physicians and need our services, and they’re important to us. By going through the clinic with a fine-tooth comb, we were able to make the changes we needed to so that we can accommodate those patients and give them and our staff a better experience.”