As I mentioned last time, when we decided to rejuvenate our
office improvement work, we wanted to address issues more broad than access to
urology consultation. Urology
Associates QI 1.0 – focused on access - had many successes including pooled
referrals, improved communication with referring physicians, and reducing
unwarranted practice variation.
But, we didn’t sustain the process.
While we’ve continued to pick away at smaller QI initiatives
in our practice, we needed to get back to a formal QI process lead by a core
team. We did not want to fall off
the wagon again. Helping us on
that path was the task we set for our new QI coach, Katherine Stevenson,
principal of The Groundwork Strategy. (Disclaimer: Katherine and I co-teach
the Canadian Medical Association’s Physician Management Institute course
“Prescribing Quality Improvement”.
Like I said in the last post, “Right under our noses…”)
While many of the broad strokes of the process Katherine has
lead us through are similar to our initial Advanced Access work (e.g. form a
core QI team with staff and physician members, regular meetings, document our
work, communicate with the other stakeholders), I see many contrasts. The Advanced Access project came with a
preset goal: Improve access to urology care. With our QI reboot, Katherine suggested that we look at our
entire office system before deciding what was the most pressing need.
This involved surveys and in-person interviews of every
urologist and staff member. We
were asked about our impressions of how our system was working, what frustrated
us and what we’d like to see improved.
This step had to be performed by someone from outside our office. Aside from the time and expertise
needed to conduct these interviews, it was apparent that uneven power dynamics
between physicians (employers) and staff (employees) would make free discussion
of at-work frustration difficult, if we tried to carry out the interviews on
our own.
Among the several common themes that Katherine extracted
from the interviews, virtually everyone mentioned problems with office
communication. There was
frustration and uncertainty around communication between staff and physicians,
between staff and patients, and between physicians and patients. Physicians weren’t sure which staff
member was responsible for specific tasks (e.g. booking tests, arranging
appointments, billing for procedures), and this lead to a lot of variation in
how each of us would assign those tasks.
Staff felt that a lot of time was taken up by answering phone calls that
could be dealt with by other means (e.g. office address or fax number, or
appointment confirmations).
Physicians felt that staff could deal with many requests that were
currently addressed by asking the physician to return the patient’s phone call
(e.g. normal test results).
My observations about these discoveries:
- Leaders
shouldn’t presume that everyone in their organization shares their view of the
most pressing issues in the workplace.
- Medical
office staff and physicians don’t necessarily understand the challenges of each
others’ work
- Small,
repetitive annoyances can weigh heavier on us than “big ticket items” like
improved access to care
- We
had found common ground between staff and physicians. Perhaps this was a topic that would get our QI work going
with a quick win that would improve work life for everyone.
Before we could start with improvements in office
communication though, we needed a robust process for our core improvement team.
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