Thinking outside the box reaps benefits for clinic
Patient access, collections have increased
East Albany (GA) Medical Center does things a little different from the typical medical practice: The support staff escorts patients and takes vital signs; a nurse reminds the patients of unpaid balances; and the entire 56-member staff, from the front desk to providers, can be in constant communication with each other via walkie-talkies. And it works.
The clinic, in rural south Georgia, employs 19 physicians and 10 physician assistants who see more than 39,000 patients a year. Patients can get an appointment within 24 hours after calling, and all patients, including walk-ins, are in and out in 45 minutes or less. After an extensive re-engineering project geared to increase efficiency and improve patient access, patient satisfaction is at an all-time high and collections are up. And the project costs very little because it uses common, off-the-shelf technology such as cordless telephones and electronic databooks.
The redesign project took place over a six-month period as four members of the clinic staff attended a six-month course in re-engineering and applied the techniques they learned to improve patient flow.
"The seminars taught us about redesign and thinking outside the box. We took those concepts and started applying them in our clinic," says Ron Malcolm, PA-C, a physician assistant and leader of Team Delta Force, the redesign team. Other members of the team were Bernard Scoggins, MD, medical director; Diane Carter, business manager; and Belinda Morrison, RN, nurse manager.
After a 90-day implementation period and trial, the redesign team is in the process of expanding the redesign to include the other six clinics operated by Albany Area Primary Health Care. Their efforts have received an Innovations in Health Care Award from the American Academy of Physician Assistants/Physician Assistant Foundation/Pfizer recognition program. The goal of the project was to increase efficiency at the clinic and cut down on lengthy waiting times for patients. The team started by taking detailed measurements of patient flow. Each team member followed patients one at a time from the time they walked in the clinic door until they left. This helped identify the problems and bottlenecks.
Their solution was to change the way the clinic operated and boost communications by using inexpensive, off-the shelf technology including walkie-talkies for all staff, electronic databooks and cordless telephones for the nurses, and computer terminals in all the treatment rooms. (See "Walkie-Talkies solve communications problem," in this issue.) "We used everyday equipment that doesn’t cost much. If you really take the time, you can see that there is a better way to do things at very little cost," Malcolm says. The biggest cost was $12,100 to buy and install computers in each treatment room.
The staff of 56 is divided into teams, which include a front desk clerk and a records clerk as well as the provider and the nurse. Some of the clerks work with more than one team. "A critical part of the redesign was training everyone on the staff to be a part of the team," Malcolm says. For instance, the front desk people and records people are trained to escort the patient to the treatment room and take basic vital signs.
Initially, the nurse director provided the training. The clinic has worked with a local technical school on a cross-training curriculum. When the clerks have finished their training and meet the proficiency standards set by the practice, they will get a step raise in hourly wages. "They are really excited and love being part of the team. It makes them feel involved with the patients," Malcolm says.
Cordless phones enable contact with pharmacy
The clinic couldn’t afford to put telephones in each treatment room but was able to buy six 900 Mhz cordless phones for each team’s nurse to use. The nurses also have electronic databooks that include pharmacy names and telephone numbers. Thus, if a patient in the treatment room isn’t sure whether her medicine needs refilling, the nurse can call the pharmacy. The process has greatly reduced the number of phone calls the practice receives for prescription refills, Malcolm says.
"We had been inundated with elderly patients calling us after their visit to say their prescription needed refilling. It added a whole level of additional work, pulling the chart, getting the approval of the provider, calling the pharmacy. This way, the proper number of refills can be made because the nurse knows when the follow-up appointment is."
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