The Polyclinic, Seattle WA
Background
The Polyclinic is one of the largest multi-specialty clinics in the Puget Sound area, with more than 15 locations and 130 primary care and specialty physicians in most areas of medicine. Established in 1917, The Polyclinic has a long tradition of delivering high quality, comprehensive care.
The Challenge
The Polyclinic sought to improve processes in several of their physician service departments, including family practice, internal medicine, Obstetricss/gynecology, dermatology and gastroenterology. Physicians worked long days finishing documentation and patient calls after seeing patients, and their production was low relative total number of hours at work. Several physician practices were closed, resulting in some new patients being turned away. Patients were unhappy with delays for services, including long 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
We implemented practice improvement solutions (A&E) 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 more timely 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 more timely manner to patient requests and better complete work throughout the day, the team also created standard work for the telephone-triage, prescription-refill processes, as well as lab tracking and results-reporting processes.
We then trained an in-house facilitator, who continued to expand the program in other departments, including orthopedics, cardiology and internal medicine.
The Results
Happier Patients |
Measure | Primary Care | Obstetrics/Gynecology |
|---|---|---|---|
| Better Access | 3rd Next Available Follow up Appointment | Reduced From 8 Days to 1 Day 88% Improvement |
Reduced From 22 days to 2 Days 90% Improvement |
| Fewer Office Delays | Cycle Time for Follow up Visit | Reduced From 25 to 15.5 Minutes 38% Improvement |
Reduced From 32.5 to 24 Minutes 26% Improvement |
Happier Physicians |
Measure | Primary Care | Obstetrics/Gynecology |
|---|---|---|---|
| Overall Physician Satisfaction | Cech Systems Survey Satisfaction level Pre vs. Post Implementation |
23% Improvement | 24% Improvement |
Happier Staff |
Measure | Primary Care | Obstetrics/Gynecology |
|---|---|---|---|
| Overall Staff Satisfaction | Cech Systems Survey Satisfaction level Pre vs. Post Implementation | 12% Improvement | 17% Improvement |
Improved Bottom line |
Measure | Primary Care | Obstetrics/Gynecology |
|---|---|---|---|
| Increased Productivity | Increase in Relative Value Units RVU Pre vs. Post Implementation | 15% Improvement | 14% Improvement |
*Survey questions for which physicians and staff reported greatest satisfaction increases:
- Patients' access to appointments (several practices opened to new patients for the first time in years)
- 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 requests, test-results reporting and phone requests
- Physician level of efficiency
- Staff level of efficiency
- Ability to leave work "on time"/sense of completion at the end of each day