Through the last few years, I have been fortunate to work alongside care teams and leadership of community health centers across the country as we try to enable a better patient experience through a better flow.
We have seen health centers facing the same questions, and make polar opposite decisions. These decisions have massive ramifications for the experience of patients and staff alike, as well as the overall performance of the health center.
Here are 5 principles that can help improve patient flow, based on our experience helping health centers across the country.
1. When in doubt, fewer exam rooms per provider are often better.
We studied over 12,000 patients visits to family practice providers, analyzing productivity, provider time with a patient, and patient alone times to understand how to improve patient flow.
One very common assumption is that assigning providers more exam rooms will speed things along. But that just isn’t the case. The data shows that more exam rooms per provider often led to worse, not better, results. Take a look at the following charts:
Providers with more rooms saw fewer patients per hour, those patients waited longer, and providers spent less time with patients for each hour they spent seeing patients.
While surprising at first, we quickly came to realize that these seemingly surprising results should not have surprised us at all, because:
- People don’t multitask well. The more tasks you try to juggle at once, the less effective you will be at each of those tasks.
- People can’t be in two places at once. This one is just thanks to physics.
While every practice is different, less is often more, especially when it comes to exam rooms.
All of this begs the question: what other common assumptions about patient flow are wrong? To know, you’ll need some metrics.
2. Know your metrics
“Make sure you are measuring the right things. Within informatics, in general, is a common mistake to measure and report of some metrics that don’t align with what you are trying to accomplish.”
– Andrew Mayhew, SyncTimes Director of Customer Success
Measuring the right data is critical to improving patient flow.
At one health center, administrators looking to improve cycle times shifted the focus to door-to-door cycle times. Medical Assistants responded by rooming patients as soon as a room became available. Imagine the administration’s shock when, the following month, patient satisfaction had decreased, despite a slight decrease in cycle times. Why? They were measuring total cycle times, which completely ignores how much of the visit was truly value-add for the patient. And, as it turns out, patients would rather wait in a comfortable, open waiting room than a lonely exam room.
Ideally, decrease alone time without sacrificing provider time.
These are the critical metrics we focus on when it comes to patient flow:
- Breakdown the cycle times. You and your team need an understanding of where the bottlenecks are so you can find ways to open them up.
- Improve productivity where it counts. Seeing more patients and spending more time with each one of them is good for both patient satisfaction and sustainability.
- Resource utilization. Understand how exam rooms, staffing, and other resources are at play. These are generally your inputs, leading to the two outputs above. By measuring them, you can get a feel for how your teams are impacted by the resources they are allocated. Allocate resources only after testing your assumptions.
3. Focus on processes, independent of people
If a process is dependent on one person, it is not really a process.
We often hear care teams announce, “Our flow is great, as long as [insert great nurse’s name here] is here!” Yet, with increasingly team-based care, dependency on any one person is not prudent, and it is often impossible.
Providing a process is the responsibility of the enterprise, not the individual care teams. While the care teams should contribute to process development (see point 4), and ultimately execute the processes, they should not bear the full responsibility of developing prudent, simple processes. That responsibility falls with the organization, generally in the operations team.
If a process fails, the system is at fault, not the individual who may have carried out the mistake. Processes reduce undesired variability for patients and ultimately may save lives.
When creating processes, the most important question is, “how can we make it simpler?” The best processes allow little room for error because they are so simple to train, execute, and measure.
4. Fostering a culture of data-driven improvement
Too often, data is hidden in an administrative office for fear of the clinicians’ response. When we implement our system with care teams, it is often the first time they really understand how patients’ time is used in their practice.
As I shared the data with one care team, they were shocked to learn that their patients were spending nearly 30 minutes alone in the room for each visit, which only averaged 12 minutes with their provider. The team was shocked. Rather than ignoring the data, they owned it and started implementing changes. Rapidly, patient wait times were reduced, and the staff’s anxiety was reduced because they used data to make smart decisions and improve their flow.
Transparency is one of the core values we practice, both as a company and with our partner health centers, is transparency. We believe in letting high performers know that they are high performers, and giving low performers the opportunity to improve. Sure, sharing data often leads to conflict. But, more importantly, it leads to real change. Often, real change only comes after the conflict. You can’t afford to preserve the peace and avoid conflict if it means your team does not perform to its best ability.
Here is how you know you are being transparent with your clinical staff:
- They will start accessing data on their own.
- They will proactively ask leadership how they are doing.
- They will actively offer suggestions, for improvement from their point of view.
Allow your clinical staff to be patient flow “owners,” not just employees. When a team has an idea, give them the freedom to test it. If the practice is measurably effective, let that same team champion their idea, bringing a practice from infancy to adoption across your enterprise.
5. Be consistent!
Once you’ve identified your end goal, come up with smaller steps to reach it. What we recommend is:
- Share consistent reports to your staff regularly. These reports should let staff know how their performance is trending, how they stack up with their peers, and how they stack up against the goals of the organization.
- Give frequent opportunities, informal and formal, for teams to express their ideas of how to improve the flow throughout the clinic.
- Continually return the focus to the patient. Make sure your team is aware that everything you do is for the patient, especially in patient flow.
While I recognize that every practice is different, I hope that one or more of these tips can help you as you continue to develop as an organization for the masses.
SyncTimes makes capturing accurate workflow data possible, communicating wait times and staff interactions. This information immediately improves provider and care team communication about the real-time status of the workflow.
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