Improving Access

by

Improving Utilization

November 12, 2012

Gina Cronin

Nate Hurle

Agenda

• What is Access?

• How is Access managed?

• Utilization Improvements in Outpatient

Setting

• How to rapidly expand improvements?

What is Access?

Key Access Measures

Cleveland Clinic

Access to Care

Right Patient with Right

Caregiver at Right Time

Appointment Access

Pre-2010

• Decentralized by department

• Personalized by provider preferences

• Highly variable by time of day

• Highly variable by staffing levels

• Disproportionate Resources

Huge Variations Average Speed of Answer

Call Abandonment

To provide an ideal patient experience by creating an environment

that delivers improved patient access to services

Efficiency

Patient

Experience

Access

Cleveland Clinic Contact Center:

The Vision

Caregiver Fears

• Loss of Control

• Wrong patients on Schedule

• Subspecialty knowledge

• Same Day Access/Nightmare

Centralized Approach >>>> Physician Mistrust

At Cleveland Clinic

• 1.5+ Million Annual

Appointments

• For 2,700+ Physicians

• In 26 Institutes

• At 25 Regional Locations

• Through 1 Access

Number

At Cleveland Clinic

Future State

• Single Point of Access

• First Time Call Resolution

• Priority Handling for Appointment Calls

• Consistent Patient Interaction

• Improve template utilization

Now Appointment Center:

• Physical Location:

- 250 Schedulers (and growing)

• Skilled Work-team:

- Schedulers for all Departments and Locations

• Technology-enabled:

- Epic Front-end Scheduling System

- Comprehensive, Specialty-Specific Questionnaires

Now Appointment Center:

• Physical Location:

- 185 Schedulers (and growing)

• Skilled Work-team:

- Schedulers for all Departments and Locations

• Technology-enabled:

- Epic Front-end Scheduling System

- Comprehensive, Specialty-Specific Questionnaires

Appointment Scheduling

as Patient Service

1) Right Appointment

2) Right Physician

3) Right Place

Clinically-Driven, Technology-Enabled

Appointment Scheduling as a Patient Service

1 + 1 Number Scheduler

= 3 + 1 Nurse

Institute Ambulatory Issues

• Provider Complaints…..

- Need more rooms

- Need more support staff

• Chairman and Administrator Partnership

with Continuous Improvement

• Deploy team to assess and recommend

Is This Access?

Institute Ambulatory Issues

• What is Reality….

• Are the rooms level scheduled?

• Are patients happy with the experience?

• Are we really managing throughput?

Outpatient Clinics

• OPDs while clinically different are

operationally similar

• We don’t have a space problem

- We have a perception of a space

problem

- The utilization of current resources

is ineffective

• We do have a patient wait time problem

Analytical Approach

1. Conduct internal caregiver survey

2. Review of Patient Experience Data

3. Perform Observational Analysis

1. Caregiver Internal Survey

Lowest Rated • Volume

- Ability to keep to pt appt

- Steady pt volume, w/out spikes

• Throughput - Pts move efficiently

- Pt wait time

• Resources - Enough support personnel

- Enough clinical providers

Highest Rated • Patient Experience

– Adapt to no shows, late, & cancelled appts

• Engagement – Pt wait time in room, before

nurse

– Checkout process quick / efficient

• Financial – All questions

Results consistent across ALL OPDS

2. Patient Experience Results

Lowest Rated

• Wait Time at Clinic

• Information about

Delays

• Wait Before Exam

Room

Highest Rated • Courtesy of

– Check-out clerk

– Registration

– Scheduling

• Convenient office hours

• Speed of check out

• Scheduling appts ease

Common Themes across OPDs

3. Observational Analysis • How well are

the rooms utilized?

• What can the patient flow through the department be improved?

• Where are opportunities to improve access?

• What can be done to reduce patient wait time?

Represents the complex timing and relationships

between patients, rooms, personnel, and assets.

Single Patient Encounter

Open

Patient

Room Usage

Patient alone in room Patient

checked in

MA Visit

Clinician Visit

Physician Visit

Room Utilization

57

40

28

22

41

0

25

50

75

100

J1-5 J2-2 J2-3 J3-4 RadOnc

% Rooms Utilized

Patient Total Visit Time

44 4063

33

144

31

5131

59

37

59

28

0

50

100

150

200

250

J1-5 J2-2 J2-3 J3-4 J4-1

(TCI)

RadOnc

Total Visit (mins)

Time Waiting Time With Provider

Utilization of Outpatient Departments

• “We need more rooms and support staff to see more patients” - Volume by 15% without more support staff or

rooms

- Decreased patient visit time by 22%

Process Changes

• Level schedule by day and within day

• Adjusted work content for MAs and RNs

• Changed room allocation

“The greatest waste, is the waste we don’t see.”

- Shigeo Shingo

Effective Way to See the Waste

• Real-Time Location Systems

- Patients and Caregivers wear Badges

- Sensors detect locations

- Software provides real-time views

Real-Time Views

Connecting Patient Flow

Patient

& Nurse

Patient

& Doctor

Available

Room

Patient Alone

> 30 minutes

Direct Connections

Direct Connections

MA has seen patient

Pt is Ready for the Physician

How is the system performing?

Visit : 1:50- 4:20

Provider: 52 mins

Pt Alone: 148 mins

Room Utilization

Low Room Usage

Low Usage

Early Afternoon

Conclusion

• Create baseline measures to

understand how resources are utilized

today

• Develop system for ongoing

measurement and communication

• Modify process to improve utilization

before adding resources

Thank You!

Questions?