Minor and James Medical, Seattle, WA

Background

Minor and James Medical is a multi-specialty medical group serving the healthcare needs of greater Seattle residents since 1959. The group today includes more than 80 physicians. Minor and James Medical is dedicated to excellence in medicine and committed to providing the community with personalized medical care.

The Challenge

Minor and James Medical sought to improve processes in its internal medicine department. Physicians worked long days finishing documentation and patient calls at the end of the day, and their production was low relative to total number of hours at work. Access was limited, and many new patients were being turned away. Patients were unhappy with delays for services, including long waits getting through on the phone and getting 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

We implemented practice improvement solutions to increase patient access and improve office flow efficiencies. To improve phone access and respond to patient requests in a timelier manner we created a call center which allowed patients to call one number for their scheduling needs and care requests. The team also created standard work for telephone-triage, prescription, refills, lab tracking and results-reporting processes. To improve access, we analyzed patient flow data, and introduced, new scheduling guidelines /visit increments and managed 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 on the patient care value stream (e.g., check-in, rooming, ordering other services and exiting the patient). The team eliminated waste, clarified care-team roles and appropriately empowered 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.

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The Preliminary Results (System implementation currently in progress)

Happier Patients	Measure	Primary Care
Better Access	3rd Next Available Follow-up Appointment	Reduced From 8.4 Days to 4.4 Days (additional providers being recruited) 48% Improvement
More Efficient Visit	Average Minutes late start for last patient of day	Reduced From 27 to 10 Minutes 63% Improvement

Happier Physician and Staff

Improvements for which physicians have noted greatest satisfaction increases:

• Appropriate visit increments (time allocated for appointments)
• Reduction in patient wait time in the office
• Improved flow of work throughout the day
• Ease of completing refill and phone requests
• Physician level of efficiency
• Physician-staff communication processes
• Ability to leave work "on time"/sense of completion at the end of each day

Improved Bottom line	Measure	Primary Care
Increased productivity	Increase in Patient Visits Pre vs. Post Implementation	Average of 10 more patients/physician per week 15% Improvement