Evergreen Orthopedic Clinic, Kirkland, WA

Background

Proliance Surgeons is one of the largest surgical practices in the country, with 135 physicians specializing in Orthopedic, Ear Nose & Throat and General Surgery. Committed to providing the highest quality of care available, the organization is made up of 33 offices in King, Snohomish, Pierce and Skagit counties in Washington and operates an ambulatory surgery center, plus MRI and physical therapy services. Evergreen Orthopedic Clinic is one of Proliance Surgeons' King County sites.

The Challenge

Dr Greg Norling, one of the practices within the Evergreen Orthopedic Clinic, recruited Cech Systems to improve processes in his practice. Primary care physicians working with Dr. Norling were dissatisfied with long delays for new-patient-consultation appointments. Dr. Norling worked long hours finishing documentation and patient calls at night and on the weekends, and his production was low relative to his total number of hours at work. His newly hired Physician Assistant was not yet fully integrated into the practice and had significant down-time and limited production. Patients were unhappy with delays for services including long waits to get an appointment, and waits in the office when he ran behind schedule. Both Dr Norling and his staff were frustrated with cumbersome work processes and a stressful pace.

Our Solution

We implemented practice improvement solutions to increase patient and referring physician 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, opened his template, and worked down appointment backlogs. Together we also developed appropriate scheduling protocol to integrate the Physician Assistant, thereby leveraging Dr Norling's office time and optimizing his operating room time. We helped streamline patient visits and keep Dr. Norling's schedule on-time by having him, his staff and the practice manager review each process of the visit value stream (e.g., check-in, rooming, ordering other services and exiting the patient) to eliminate waste, clarify care team roles and empower everyone involved to complete their work more easily. We designed new medical-record forms and communication tools to help Dr Norling complete his documentation at the time of visit, rather than at the end of the day. We also provided weekly reports to measure the process change and tracked the care team's progress toward improvement goals.

The Results

Happier Patients	Measure	Orthopedic Surgeon
Better Access	3rd Next Available Consult Appointment	Reduced From 20 Days to 3 Days 85% Improvement
More Efficient Visit	Cycle Time for Consult	Reduced From 45 to 30 Minutes 33% Improvement

Happier Physician and Staff

Dr Norling went home earlier with a greater sense of completion at the end of the day, all while improving the team's production.
With greater clarity of his role and responsibilities, the Physician Assistant was empowered to complete his duties more independently, and contribute more effectively to the team.

Improved Bottom line	Measure	Orthopedic Surgeon
Increased New Patient Consults	Increase in # of New Patients per Week Pre vs. Post Implementation	Increased From 8 to 15 88% Improvement
Increased Surgeries	Increase in # of surgeries per Week Pre vs. Post Implementation	Increased From 4 to 7 75% Improvement
Increased productivity (Surgeon and PA)	Increase in Receipts Pre vs. Post Implementation	23% Improvement