Background
Healthcare in the United States is a complex and multi-faceted system. It is a mix of private and public healthcare providers and insurance options. The United States has a wide range of healthcare providers, including hospitals, clinics, physicians, specialists, and other healthcare professionals. These providers can be part of private practices, non-profit organizations, or government-funded institutions.
Our client is one of the most progressive and integrated health care organizations in the United States. They bring together more than 720 primary care physicians and specialists across over 90 clinics, providing dedicated physician coverage and high-quality medical services. The client was looking for ways to increase performance of their practices, allowing for better capacity utilisation and increased patient satisfaction to deal with the increasing demand for services.
Analysis
Our initial survey of the client’s operations identified the following areas of concern:
- Structured management tools (data driven KPIs, short interval control rounding, variation analysis, action logs, performance reviews) were largely missing
- Significant overlap of responsibilities and accountability throughout the process
- Communication between top management and the practices was ineffective and not structured
- The flexibility of staff varied greatly between practices
- Workload allocation was inconsistent between like practices
- The administrative aspects of running the practices were done in a mostly reactive manner
- Patient slots in same type practices varied
- There were noteworthy differences in how waiting times were managed and how patients were assisted
Project Approach & Implementation
Following the results of our analysis, we worked together with the client to implement the following milestones:
- Standardise management control systems (MCS) across clinics and “suit to fit”
- Standardise work processes such as checking in and rooming
- Develop daily, weekly, and monthly operating reports to highlight individual clinic/physician performance
- Improve Short Interval Control rounding to focus on standard work times
- Increase patient visits by improving physician productivity
- Implement a governance model to create a continuous improvement culture
- Resource load clinics based on work/time relationships
- Develop overtime control to minimise costs
- Create better delegation and clarity of roles and responsibilities
- Standardise referral management and review process
- Increased performance of practices allowing for better capacity utilisation and increased patient throughput
To drive the transformation project, we formed a task force consisting of our consultant and client-side staff to oversee the development and implementation of all the solutions in this project. Two management action teams (MATs) were also established to provide a feedback loop for process changes and ensure data credibility.
One MAT provided open dialogue among physician champions, senior leadership, clinical support personnel, and the task force to discuss processes identified at the site level, applicable KPIs to gauge improvement, and desired targets for the clinics to achieve. The other MAT provided support by addressing data capability queries as well as resolving data credibility concerns.
Active engagement within the MATs allowed the client’s own leadership to understand the underlying concerns across different clinics. Through our critique sessions that took place throughout the duration of the project, the client was able to identify a model consistent with their executive leadership’s vision.
A thorough 15-week Focus Process™ allowed the task force (with guidance from our people) to identify 41 best practices prevalent among the client’s best operationally performing clinics. These best practices focused on site-level processes and individual responsibilities to ensure that the complexities of each patient, in both primary and specialty care clinics, received the best quality of service, in the most predictable manner possible.
Key Results
Up to US$20 million in savings
326%
Improvement in 1st appointment on-time performance
33%
Reduction in lobby wait time
68%
Reduction in 1st appointment average exam delay department
28%
Reduction in patient throughput
102%
Improvement in overall on-time performance
55%
Reduction in overall average exam delay
Patient-centred care enhances trust, communication, and shared decision-making between patients and healthcare providers. It also increases patient satisfaction, which positively impacts reputation and attracts new patients. In the long term, our work with the client to prioritise the patient experience will go a long way in benefiting patients, the client, and the healthcare system as a whole.
