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Improve Workflow and Remove Waste

Improving Primary Care Access

Improving the flow of work and eliminating waste ensures that the clinical office runs as efficiently and effectively as possible. Some reports estimate that up to 40 percent of clinical office work is redundant or otherwise wasted effort. Examples include staff taking messages and looking for a chart for a repeat phone call requesting a prescription refill, or preparing for an office visit and the patient doesn’t show up for the appointment. This change idea addresses concepts aimed at improving work flow and recognizing and eliminating waste.

Changes for Improvement

Use Continuous Flow to Avoid Batching

Balance Supply and Demand on a Daily, Weekly, and Long-Term Basis
The foundation of improved access scheduling is the matching of supply and demand on a daily, weekly, and long-term basis.
Create Contingency Plans
The natural variation in supply and demand that occurs as part of the everyday functioning of a practice often creates problems that contingency plans can address
Decrease Demand for Appointments
Reducing the amount of demand makes it easier for the system to absorb current or future levels of demand.
Manage Panel Size and Scope of the Practice
Managing panel size and the scope of the practice allows a team to balance supply and demand and ensures that they can do today's work today.
Measure and Understand Supply and Demand
Understanding the patterns of both demand and supply on a weekly, monthly, or seasonal basis allows for focused efforts to shape demand to match supply, and/or increase (or decrease) supply during periods of high (or low) demand
Optimize the Care Team
Optimizing the care team is critical to maximizing the supply of the clinic and improving the daily flow of work.
Predict and Anticipate Patient Needs
To ensure that patient needs are met and that patients flow smoothly through the clinic process, staff look ahead on the schedule to identify patient needs for a given day or week.
Recalibrate the System by Working Down the Backlog
Backlog consists of appointments on the future schedule that have been put off due to lack of space on the schedule to do this work sooner; working down the backlog recalibrates the system to improve access.
Reduce Scheduling Complexity
Complex schedules, with many appointment types, times, and restrictions, can actually increase total delay in the system because each appointment type and time creates its own differential delay and queue. Reducing the complexity ultimately decreases system delays.

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User Comments

Minutes Behind Graph
A "Minutes Behind" graph is a very helpful way to show graphically the effect of providers starting late/staying late, starting late/catching up, and starting on time/getting late.
Patient Cycle Tool
Once the team determines where the waits and delays are occurring, it can take steps to minimize the constraint or, in some cases, eliminate it. One key measure of office efficiency is the patient cycle time.
Rooming Criteria Example
Standardizing the process for rooming patients by diagnosis increases efficiency and decreases variation.
Standard Room Stocking Checklist Example
Standardizing supplies and inventory leads to decreased rework, high predictability of needed supplies being present, and fewer interruptions to the flow of patient care.