Swedish Physicians, Seattle WA
Background
Swedish Physicians is a network of 12 primary-care clinics including more than 80 physicians, ARNPs and Physician Assistants. Swedish Physicians is owned by Swedish Medical Center and enjoys a reputation of providing excellent health care throughout Greater Seattle and the Eastside.
The Challenge
Swedish Physicians sought to improve processes in several of their clinics. Physicians worked long days finishing documentation and patient calls after seeing patients, and their production was low relative to the number of hours spent at work. Several physician practices were closed, resulting in new patients being turned away. Patients were unhappy with delays for services, including long waits in phone queues, 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 in eight Swedish Physician Clinics between 2000 and 2004:
| Greenlake Clinic | 8 family practice physicians |
| Ballard Clinic | 5 family practice/internal medicine physicians |
| Healthcare for Women | 5 Obstetricss/gynecology physicians, 1 ARNP |
| Providence Clinic | 7 family practice physicians |
| Pine Lake Clinic | 4 family practice physicians, 3 ARNPs |
| Magnolia Clinic | 4 family practice physicians, 1 ARNP |
| Children's clinic | 4 pediatricians |
| Downtown Clinic | 7 internal medicine/family practice physicians |
To improve access, we measured demand and capacity, analyzed patient flow data, introduced new scheduling guidelines and visit increments, and worked down appointment backlogs. In their OB/GYN clinic, we developed a new call schedule to optimize physician time in the office and hospital and ensure high quality delivery services. 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 visit value stream (e.g., check-in, rooming, ordering other services and exiting the patient) to eliminate waste, clarify care team roles and appropriately empower the staff and physicians to complete their work more easily. We designed new patient history/examination forms to reduce intake time and improve medical records documentation. We provided weekly reports to measure the process changes 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 | Obstetrics/Gynecology |
|---|---|---|---|
| Better Access | 3rd Next Available Follow up Appointment | Reduced From 6 Days to 1 Day 83% Improvement |
Reduced From 23 Days to 6 Day 74% Improvement |
| More Efficient Visit | Cycle Time for Follow up Visit | Reduced From 36 to 21 Minutes 42% Improvement |
Reduced From 39 to 25 Minutes 36% Improvement |
| Greater Overall Satisfaction | Clinic Survey (view detail) Satisfaction level Pre vs. Post Implementation* | 55% Improvement | N/A |
Happier Physicians |
Measure | Primary Care | Obstetrics/Gynecology |
|---|---|---|---|
| Increased Physician Satisfaction | Physician Satisfaction Survey Satisfaction level Pre vs. Post Implementation |
Increased From 2.7 to 3.5 27% Improvement |
Increased From 2.8 to 3.6 29% Improvement |
Happier Staff |
Measure | Primary Care | Obstetrics/Gynecology |
|---|---|---|---|
| Increased Staff Satisfaction | Staff Satisfaction Survey Satisfaction level Pre vs. Post Implementation | Increased From 3.4 to 3.9 17% Improvement |
Increased From 2.9 to 4.1 40% Improvement |
Improved Bottom line |
Measure | Primary Care | Obstetrics/Gynecology |
|---|---|---|---|
| Increased Productivity | Increase in Relative Value Units (RVU) Pre vs. Post Implementation | 14% Improvement | 9% 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
- Physicians went home earlier each day (as much as 1 hour earlier)
