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Wilmer Cuts 15 Minutes from Patient Wait Time

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Wilmer Cuts 15 Minutes from Patient Wait Time

Wilmer Cuts 15 Minutes from Patient Wait Time

The Wilmer team, from left to right, Eric Singman, Lisa Toon Alexander, Karen Shafer, Albert Jun and Samantha Murphy.

Date: 05/01/2016

Eric Singman faced a puzzling problem. He had measured how long patients spent with the ophthalmology technician before and after he and his colleagues at the Wilmer Eye Institute completed a quality improvement project. That time period was supposed to shrink, yet it slightly lengthened.

“Then we realized: We were looking at the wrong metric!” says Singman, who is chief of Wilmer’s general eye service. “Instead of measuring the time between ‘Hello’ and when the tech was finished preparing the patient for the doctor, we needed to measure the time between ‘Hello’ and when the patient was dilated and ready to see the doctor.”

The distinction may sound subtle, but the process changes that Singman and his colleagues made as part of their work for the Ambulatory Management Program (AMP) reduced by 15 minutes the time between check-in and readiness for the examination.

AMP, which is sponsored by the Office of Johns Hopkins Physicians, trains physician-administrator-nurse teams in Lean, a quality improvement methodology. During and after the four-month program, participants take what they learn back to their clinics. Then, with their staff’s help, they identify quality improvement goals and work together to achieve them.

“One strength of Lean is that it enables those trained in it to take a fresh look at familiar processes, see their problems and then find a better way,” says John Flynn, vice president of the Office of Johns Hopkins Physicians and the organizer of the program.

It was training in Lean, says Singman, that altered how he and his colleagues looked at patient time in the waiting room, which patients saw as frustrating dead time. “We made a simple but mission-critical adjustment in what we were measuring and got to the heart of the problem.”

Re-Engineering the Process

The changes that Singman and his colleagues implemented as part of AMP concerned the order in which the techs performed their work. The process had been that the tech asked the patient a series of questions before administering dilation drops. Then the patient returned to the waiting room for the drops to do their work so the ophthalmologist could perform the exam. The wait lasted 15 to 30 minutes.

In the new approach, the tech asks a few basic questions, including the reason for the visit and the presence of any allergies; administers the drops; then continues with more detailed questions while the pupils dilate. “You don’t need your pupils undilated to answer questions about family history,” says Singman. By the time the tech is finished, the patient is ready to see the doctor. This minimizes time spent in the waiting room.

Lasting Value

The AMP team measured patient satisfaction before and after the change. Not only did it improve, but so did staff satisfaction.

Singman attributes this success to AMP: “The program provided the vocabulary and tools to approach problems as a team,” he says. “And the best thing is that now everyone looks for other opportunities to improve.”

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