Mark Wendling, MD, Associate Medical Director of Performance Improvement
Michael Sheinberg, MD, Associate Medical Director of Performance Improvement
Barbara Salvadore, RN, Director of Nursing
Theresa Ryan-Mitlyng, MD, Medical Director
Stephen Kaja, Associate Executive Director of Operations

To decrease the number of incoming phone calls by at least 10 percent.

Number of incoming phone calls per day

• Developed a weekly team meeting
• Developed a series of goals as a participant in OPOS Collaborative of IHI's IMPACT network
• Tested new locations for scheduling printers
• Decreased number of scheduling types
• Increased length of scheduled day for a period of time
• Began working down backlog
• Realized significant improvement in delays
• Scripted staff members on access
• Tested new planned care teams
• Deployed all teams throughout practice including MD/CRNP/RN/MA
• Gathered information on current phone system
• Identified an individual who would be the operator
• Developed three different call queues:
  • Known extension
  • Schedule appointment
  • Talk to operator
• Phone system reprogrammed
• Tested new operator model
• Implemented operator
• Realized significant reductions in call volumes

This project clearly demonstrates how systems within an outpatient practice are interrelated.  The results of the project show that total phone call volume can be decreased by simplifying the phone system, and combining that effort with a practice redesign, which makes that system efficient and operational.  In our case, we developed teams of care and advanced access concurrent with phone system redesign, which was very effective.

• Do not change one system within an outpatient practice without taking into account other systems with which it relates.
• Test the changes you wish to employ simultaneously and by themselves.
• Incorporate all people who know the systems in your team.
• Trust that technology will not answer all of your problems.
• Decreasing handoffs, touches, and rework applies to phone systems as well as other systems.
• Do not trust that people fully understand their phone systems or any other system in a practice.
• Do not buy a phone system that cannot give you data.

Mark Wendling, MD, Associate Medical Director of Performance Improvement
Lehigh Valley Physician Group
Mark Wendling@lvh.com

[Storyboard presentation at IHI's National Forum, December 2004]