The Everett Clinic, Everett, WA

Background

The Everett Clinic is a nationally recognized locally owned physician group practice with nearly 300 physicians and 1500 staff. They specialize in more than 40 medical, surgical and diagnostic fields in more than 16 locations throughout Snohomish County.

The Challenge

OB Department: The Everett Clinic was interested in improving the overall performance of the OB department. The department was decentralized and several satellite locations had significant office to hospital drive times. The physicians' call duty was onerous, and the department was not meeting targets for productivity, access, physician retention/recruitment or operating income.

Pulmonary, Endocrinology, OB, and Cardiology Departments: The Everett Clinic was interested in improving processes in these physician service departments. Physicians worked long days finishing documentation and patient calls after seeing patients, and their production was low relative to total number of hours at work. Patients were unhappy with delays for services, including long waits on the phone, waits to get an appointment and waits in the office when physicians ran behind schedule. Staff and physicians were frustrated with cumbersome work processes and a stressful pace.

Our Solution

OB Department: We facilitated the decision to consolidate the department into one location adjacent to the hospital. We introduced a new system for scheduling physician time that more evenly distributed call duty and optimized surgery time, office hours and time off. To support these changes and the practice improvement changes outlined below, we also implemented an improved back office staffing model and surgery scheduling process.

Pulmonary, Endocrinology, OB, and Cardiology Departments: We implemented practice improvement solutions to increase patient access and improve office flow efficiencies. To improve access, we measured demand and capacity, analyzed patient flow data, introduced new scheduling guidelines and visit increments, and worked down appointment backlogs. To streamline patient visits and run on a timelier daily schedule, we facilitated weekly meetings in which physicians, staff and managers reviewed each process (check-in, rooming, ordering other services and exiting the patient) to eliminate waste, clarify care-team roles, and appropriately empower the staff to complete their work more easily. We provided weekly reports to measure the process change and tracked the care team progress toward improvement goals. To respond in a timelier manner to patient requests and better complete work throughout the day, the team also created standard work for telephone-triage, prescription-refills, lab tracking and results-reporting processes.

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The Results

Happier Patients	Measure	Obstetrics/Gynecology	Cardiology	Pulmonary/Sleep Disorders
Better Access	3rd Next Available Follow up Appointment	Reduced From 57 Days to 18 Days 68% Improvement	Reduced From 57 Days to 18 Days 29% Improvement	Reduced From 21 days to 16 Days 23% Improvement
More Efficient Visit	Cycle Time for Consultation/Treadmill	Reduced From 32 to 24 Minutes 25% Improvement	Reduced Treadmill From 60 to 43 Minutes 28% Improvement	Reduced From 58 to 44 Minutes 24% Improvement
Quicker Phone Response	Average Speed to Answer the Phone	N/A	Reduced From 2:22 to 0:44 Minutes 69% Improvement	Reduced From 2:05 to 0:49 Minutes 61% Improvement

Happier Physicians	Measure	Obstetrics/Gynecology	Cardiology	Pulmonary/Sleep Disorders
Increased Physician Satisfaction	Physician Satisfaction Survey Satisfaction Level Pre vs. Post Implementation*	N/A	22% Improvement	37% Improvement

Happier Staff	Measure	Obstetrics/Gynecology	Cardiology	Pulmonary/Sleep Disorders
Increased Staff Satisfaction	Staff Satisfaction Survey Satisfaction Level Pre vs. Post Implementation	N/A	31% Improvement	24% Improvement

Improved Bottom line	Measure	Obstetrics/Gynecology	Cardiology	Pulmonary/Sleep Disorders
Increased Patient Visits	Patient Visits Pre vs. Post Implementation	12% Improvement	19% Improvement	2% Improvement
Increased New Patient Consults	New Patients per Week Pre vs. Post Implementation	22% Improvement	15% Improvement	15% Improvement
Increased Surgeries	Surgeries per Week Pre vs. Post Implementation	23% Improvement	N/A	N/A

*Survey questions for which physicians and staff reported greatest satisfaction increases:

• Patients' access to appointments
• Appropriate visit increments (time allocated for appointments), and staff ability to schedule accordingly
• Reduction in patient wait time in the office
• Improved flow of work and ability to dictate throughout the day
• Ease of completing refill requests, test-results reporting and phone requests
• Physician level of efficiency
• Staff level of efficiency; back office staffing model and clarity of roles
• Ability to leave work "on time"/sense of completion at the end of each day