Friday, June 27, 2008

Calling All Patients

It had been a month since our last team meeting, so I was happy – and a little relieved – to meet again last week. Now that we’ve distilled our project team down to just members of our office staff and physicians, there’s a temptation to let regular meetings slide.

I had a proposal for our next mini-project: reducing our no-show rate. Our no-show rate usually runs between 10-15%. That’s unused capacity that could help get rid of our backlog, reduce wait times and, as a bonus, increase revenues.

Great idea, right?

Amanda had already thought of it. And, as part of her Clinical Practice Redesign (CPR) School work, had carried out a test of change. And she showed us the results.

Since the week of May 12, a staff member has been confirming appointments by calling all patients a week in advance.

Since implementing that change, our no-show rates have all been below the median (10.88%).

But, that's a lot of phone calls. Maybe we can target people at "high-risk" of not keeping appointments. Perhaps we only need to remind new referrals, or people from out-of-town. We'll take a look at some of the characteristics of our no-shows to see if we can cut down the number of calls needed.

If that doesn't work, and we decide that routine reminder calls are valuable, Amanda has heard (through her CPR classmates) of online automated telephone messaging services we may want to explore.

While the no-show rate is one of our project's benchmarks, a lower no-show rate doesn't necessarily translate to reduced wait times. Our no-show rate is the number of no-shows divided by the total number of patients scheduled. It doesn't include empty appointment slots. So, if we've phoned our patients and identified those who aren't planning to attend their appointment, we'll reduce our no-show rate, but may be left with unfilled slots. If the staff responsible for booking appointments aren't notified about those newly-opened slots, the time remains unused. That's wasted capacity.

Perhaps "wasted" is the wrong word. One of my partners took me to task for describing unfilled appointment slots as wasted time. He pointed out that no-shows give him the chance to return phone calls and catch up on paperwork. I've heard similar comments from other physicians during Advanced Access discussions. That is, they're not really upset about no-shows because there's always plenty of other work to fill in those time slots.

Friday, June 13, 2008

Booster Shot

Sometimes I wonder: Is there anyone else out there?

When I go for a stretch without connecting with anyone who's engaged in quality improvement work, I feel a little isolated.

But I’ve had a great couple of weeks, with plenty of chances to connect with people who are truly excited about the quality improvement opportunities they’re pursuing.

I started out at HQC’s Clinical Practice Redesign (CPR) school. Participants from clinics and health regions are learning to apply QI techniques in their clinical work.

And they ask some tough questions, like “What would you do differently, if you could do Advanced Access over again?”  Ummmm…2 things.

First, I would ask for more time set aside for this project
. When I took on the Urology Division head position, I asked for a half-day every month to pursue administrative activities. I usually split that into two 2-hour chunks. At the time, I thought that was a lot to ask, given that our practice is fee-for-service and administrative work doesn’t pay the bills.

Ha! What a rube! I got owned… big time.