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Providence uses Six Sigma to reduce patient wait time
'Data are the cornerstone'
By Rebecca Coplin, Director, Seamless Access, Providence Health System, Portland, OR
(Editor's note: In the first segment of a two-part series, Rebecca Coplin, one of 15 Providence managers chosen to participate in an intensive Six Sigma training course, discusses the infrastructure the organization has in place to ensure process improvement. In next month's issue, Coplin describes two access initiatives aimed at simplifying the registration process — centralized preregistration and check-in kiosks — that are receiving high praise from patients.)
In keeping with our service-oriented mission and our core value of excellence, Providence Health System has made significant investments in people and training, the keys to lasting process improvement.
In 2002, Providence began a journey with Six Sigma. Six Sigma is a logical, data-driven, statistical approach to identifying problems, implementing solutions, and maintaining positive results. While the principles of Six Sigma have been used for decades in manufacturing, only recently have they been applied to health care.
Fifteen of our managers were invited to participate in a rigorous six-week training course taken over the span of six months. Each trainee selected a project on which he or she could practice the Six Sigma framework. One project selected was to reduce wait times for outpatient services, such as unscheduled labs and X-rays. (See flow diagram of project's scope below.)
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A project team was assembled and we quickly realized accurate wait time data were not available. Anecdotally, we knew patients were frustrated with the wait but we couldn't monitor or report on the magnitude of the problem.
Because data are the cornerstone of Six Sigma, a manual data collection process was established. Once wait times were measured, we surveyed patients to understand their expectations. Patients told us they expected to be registered and waiting for their service within five minutes. Our average wait time was more than 10 minutes.
Next, detailed data were collected on each registration. To understand why one registration took six minutes and another took two minutes, registrars filled out a short form for each patient. The form listed 30 factors that might make a registration time-consuming. The registrar circled all factors that applied and then recorded how long the registration actually took.
When the project team analyzed the data with statistics, several key factors were revealed to cause long registrations. These were: the patient was talkative and had questions; demographic/insurance data were updated; the order was missing; and the patient could not quickly locate his or her insurance card.
The project team brainstormed solutions for each of these. To assist when the patient was talkative or had questions, registrars received scripting and training on how to politely close the conversation. To expedite demographic/insurance updates on the host computer, the project team recommended implementing kiosks to allow patients to update personal information themselves. To reduce the number of missing orders, an order tracking system was developed internally. Finally, to remind patients to have their insurance cards handy, signage was improved.
Thanks to the rigor of Six Sigma, these changes helped bring our wait time in line with patient expectations. "Six Sigma is becoming the way we do things at Providence," says Gail Mitchell, regional director, access services. "The investment has been invaluable."
Providence's second major investment was creating a unique department to improve processes related specifically to patient access. At Providence, we take being an integrated delivery system very seriously. We want our patients' experiences to be seamless as they receive care at different Providence entities. Aptly named, the Seamless Access department has worked with our seven Oregon hospitals, our 40-plus physician clinics, our home services division, and our 250,000-member health plan to, very simply, know our patients.
With each entity operating different core systems, the road to seamless access was paved with many challenges. We couldn't share data. We repeatedly asked our patients for their address, phone number, and insurance information. Our patients wondered why our different sites didn't "talk" to one another.
The biggest milestone for Seamless Access will be when Providence installs a new enterprise master patient index system. While this is several years away, the Seamless Access, Information Services, and Access Services departments, among others, are busy discussing requirements. Providence hopes to connect its hospitals, clinics, health plan, and home services one day.
In the meantime, Seamless Access has focused on process improvement within the billing offices and within Access Services.
A centralized call center was established for billing questions. Call center representatives were trained on both the hospital and the clinic billing systems. Representatives could help patients with account questions, demographic or insurance updates on both accounts with one phone call. We made ourselves more efficient and saved our patients a phone call at the same time.
To make paying hospital and clinic bills more seamless for our patients, a web site that accepts payments for either account was developed. Patients click on a picture of their bill to ensure that payment is directed to the right billing system. Patients enjoy the convenience of paying via the web; the billing office likes having this process automated.
The on-line payment application has improved processes for Access Services as well. Registrars can process credit card payments of co-pays faster than ever before. Registrars toggle to the payment web site and enter the patient's account number. The patient's name and address auto-fill into the on-line payment screen. Once the credit card number is typed in, the transaction is sent and a receipt prints. Registrars no longer walk to a shared credit card terminal and handwrite receipts.
In keeping with our service-oriented mission and our core value of excellence, Providence Health System has made significant investments in people and training,...You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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