Skagit Valley Medical Center, Mount Vernon, WA
Background
Skagit Valley Medical Center is a multi-specialty medical group that has served the healthcare needs of Skagit Valley residents since 1971. The group was founded by nine general practitioners, and today includes more than 100 physicians and allied health care professionals. Skagit Valley Medical Center is dedicated to excellence and patient satisfaction, and committed to providing the community with high quality, compassionate medical care.
The Challenge
Skagit Valley Medical Center sought to improve processes in its Sedro-Woolley primary care clinic. Physicians worked long days and finished documentation and patient calls at the end of the day, and their production was low relative to total number of hours at work. New patients were being scheduled more than 75 days in the future, and many were 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 to increase patient access and improve office flow efficiencies. To improve access, we measured demand and capacity, analyzed patient flow data, and introduced open access, new scheduling guidelines and visit increments. 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 physicians and 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.
The Results
Happier Patients |
Measure | Primary Care |
|---|---|---|
| Better Access | 3rd Next Available New Patient Appointment | Reduced From 57 Days to 39 Days (addition providers being recruited) 32% Improvement |
| More Efficient Visit | Cycle Time for Follow up Visit | Reduced From 37 to 28.7 Minutes 22% Improvement |
Happier Physicians |
Measure | Primary Care |
|---|---|---|
| Increased Physician Satisfaction | Physician Satisfaction Survey Satisfaction level Pre vs. Post Implementation* | Increased From 2.5 to 4.3 72% Improvement |
Happier Staff
Though staff was not formally surveyed, they shared anecdotally many of the same increases in satisfaction noted above by physicians. They were especially pleased with new scheduling guidelines which streamline the scheduling process and eliminated the "morning phone chaos" (a system which required an average of 84 patients per week to call back the same day they wanted an appointment).
Improved Bottom line |
Measure | Primary Care |
|---|---|---|
| Increased productivity | Increase in Patient Visits Pre vs. Post Implementation | 9% Improvement |
*Survey questions for which physicians reported greatest satisfaction increases:
- Patients' access to appointments
- Appropriate visit increments (time allocated for appointments)
- 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
- Physician-staff communication processes, improved staffing model and cross-coverage
- Ability to leave work "on time"/sense of completion at the end of each day