Transforming Access to
Care and Services at
Holland Bloorview
A Redesign of Appointment Services
Draft Report
May 2014
CSI
Consultancy
TABLE OF CONTENTS
EXECUTIVE SUMMARY .......................................................................................................................2
1.0
SETTING THE CONTEXT ........................................................ ERROR! BOOKMARK NOT DEFINED.
1.1
Confirming Goals and Deliverables
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1.2
Validating the Need for Change and Action
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2.0
BUILDING A VISION FOR TOMORROW ................................. ERROR! BOOKMARK NOT DEFINED.
3.0
UNDERSTANDING OUR STARTING POINT ............................. ERROR! BOOKMARK NOT DEFINED.
3.1
Appreciating the Strengths of Appointment Services
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3.2
Confirming Current State Issues & Challenges to Address Error! Bookmark not defined.
3.3
Identifying Opportunities for Further Review
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4.0
DESIGNING AN INNOVATIVE MODEL FOR CARE.................... ERROR! BOOKMARK NOT DEFINED.
4.1
Referral Receipt Process
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4.2
Intake/Review Process
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4.3
Scheduling Appointments
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4.4
Client and Family Has Questions
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4.5
Managing Cancellations and No-Shows
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4.6
Client Appointment Completed
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4.7
Interpreter Services Delivered
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4.8
Follow-Up Appointment(s) Scheduled
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5.0
BUILDING A PLAN FOR MOVING FORWARD ......................... ERROR! BOOKMARK NOT DEFINED.
5.1
Developing an Implementation Workplan
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5.2
Prioritizing Recommendations
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5.3
Identifying Projects on the Critical Path
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5.4
Setting Up Appointment Services for Success
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5.5
Establishing a Solid Implementation Structure & Supports Error! Bookmark not defined.
5.6
Evaluation Framework
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APPENDIX ....................................................................................... ERROR! BOOKMARK NOT DEFINED.
A.1 Operational Review Assessment Participants
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A.2 LEAN Redesign Session Participants
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A.3 Operational Assessment Areas of Focus & Prioritization
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A.4 Future State Process Maps for Appointment Services
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A.5 Multi-Phase Implementation Workplan
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Eliminating Barriers to Access: Creating New Roads to Care - A Plan to Enhance Urban Telepsychiatry
CSI Consultancy Inc. © 2014
1
EXECUTIVE SUMMARY
Appointment Services is the first person a Holland Bloorview family speaks to, and is critical to setting the
stage for a welcoming, efficient and memorable experience for clients, families and referring providers.
However, Appointment Services is also a key point of contact to collect valuable information; plays an
important linkage to other services or areas within the hospital; and provides critical information to help
navigate clients and families to their next destination of care.
Setting Clear Goals and Expectations
Holland Bloorview initiated a comprehensive review of Appointment Services to achieve some key goals.
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Establish a single,
coordinated point of access
Standardize the way
referrals are processed
Reduce administrative
burden on staff
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Reduce anxiety and burden
of the family experience
Create standardization and
transparency in scheduling
Minimize cancellations and
no-shows
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Enhance partnerships with
referring providers
Streamline processes for
accessing interpreters
Optimize use of clinic and
therapy resources
Confirming the Need for Change
Through engagement with over 40 stakeholders including four (4) family members as part of an
operational assessment conducted over 3-days, nine (9) rapid redesign sessions, and six (6) follow-up
recommendation review meetings, the need for change was confirmed.
Specifically, stakeholder consultations and consultant observations confirmed that there is a clear need
to improve Appointment Services; the need to move forward with change is now; and the risk to the
organization of not pursuing recommendations contained in this report is significant. While Appointment
Services is in no-way on the brink of failure, staff within Appointment Services and stakeholders of
Appointment Services confirm that there are processes that result in non-value added work; that
processes are resulting in patients waiting longer to access services; and that limited physician, therapy
and space resources are not optimally being utilized.
Establishing a Vision to Guide the Change
To transform how clients and families access care and services, Holland Bloorview must shift its mindset
from an “organization centric intake model” to a “client and family focused approach to intake” where the
primary goal is to establish a streamlined, coordinated point of entry. Key attributes of this vision include:
an exceptional patient and family experience; effectively and timely communication amongst the Holland
Bloorview team; accessible services reducing patient waits; optimal use of limited resources; smooth
transitions and flow of clients; standardized and efficient work processes; and patients and families
actively participating in their care.
Understanding the Starting Point for Change
To achieve this vision, Holland Bloorview will rely on a number of strengths. These include its dedicated
Appointment Services team of professionals working together to meet the needs of the clients, families
and the organization; and a willingness and readiness for change. However, Holland Bloorview must also
understand the landscape within which changes will be implemented. This includes an environment
which has a high level of accommodation to physician and therapy schedules, existence of a number of
band-aid solutions, and a need to look at the broader journey of patients beyond simply Appointment
Services.
Eliminating Barriers to Access: Creating New Roads to Care - A Plan to Enhance Urban Telepsychiatry
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The Operational Assessment identified six areas of issues and challenges that need to be addressed.
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Variability in work processes and lack of standardization creates unnecessary workload;
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Scheduling processes are inherently manual requiring constant monitoring and added workload;
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Too many spreadsheets that create significant manual workload;
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Utilization and allocation of limited resources like space and clinicians must be monitored closely;
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Communication gaps create added workload and frustration; and
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Interpreter service processes are highly manual and result in cost inefficiencies.
As a result of the operational assessment work, twenty-three (23) areas were identified as requiring
further investigation as part of the rapid LEAN redesign sessions. 9 recommendations were prioritized
and reviewed as part of the rapid redesign sessions.
Designing an Innovative Model for Care
To achieve the vision and address challenges and issues within the current process, eight building blocks
have been identified for change – each reflecting a key step along the patient care journey. These include:
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Streamlined Referral Receipt Processes. In the future, a streamlined referral receipt process will be
led and coordinated by Appointment Service enabling timely review of referrals for completeness;
capture of referral forms into the Meditech system; ensure referring providers are notified when the
referral has been received; and appropriate transfer of the referral information electronically to the
right Intake/Review person for timely review using standardized processes.
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Smooth and Quick Intake and Review Process. In the future, referrals will be reviewed and
processed in a timely, standardized fashion resulting in the collection of additional, value-added
information; a clear and confirmed decision on when to schedule the visit; and timely electronic
communication of scheduling information back to schedulers.
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Optimal Scheduling of Appointments. In the future, Appointment Services will contact clients to
discuss and confirm an appropriate, acceptable appointment date; and clinic schedules will be
developed that will be optimized for productivity and efficiency.
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Answering Clients and Family Questions. In the future, clients and families will have easy means to
get their questions answered, either on a self-serve basis or by calling Holland Bloorview and speaking
to an informed individual who has the answers they seek or knows how to get them.
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Managing Cancellations and No Shows. In the future, Holland Bloorview will actively manage its
high cancellation and no-show rate for services by changing how it communicates with clients/
families to find a time that will work for them; and reduce organizational initiated cancellations.
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Client Appointment Completed. In the future, Holland Bloorview will ensure client’s entry to the
building for their appointment is smooth; that they find the clinic/therapy location easily; and receive
an exceptional care and experience.
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Interpreter Services Delivered. In the future, clients and families who require an interpreter will
receive the interpreter for the first visit but a comprehensive process will be used to confirm
subsequent visits; and alternative, cost-effective, high quality interpreter models will be investigated.
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Follow-Up Appointment(s) Scheduled. In the future, follow-up appointments will be managed by
Appointment Services but will be decentralized to clinic/therapy areas where feasible to enable
clients to book an appointment or schedule a pending appointment while they are still at Holland
Bloorview. This work will build on the CSR project.
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Developing an Implementation Workplan
44 recommendations were identified as part of the Appointment Services review – 35 recommendations
were identified as priorities to move forward and nine (9) recommendations were deferred as longer term
efforts. To ensure there is a clear focus and understanding for how Holland Bloorview’s patients, families,
and providers will benefit, recommendations have been grouped into five outcome categories:
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Transforming how we engage our referring providers (4 recommendations);
Transforming how we partner with patients and families (5 recommendations);
Innovating how we manage referrals and scheduling (8 recommendations);
Enhancing efficiency and productivity (12 recommendations); and
Enhancing interpreter services and access (6 recommendations).
A multi-phase workplan has been developed to guide the implementation efforts (see Appendix A5).
Understanding the Priority Projects
To transform how clients and families access care at Holland Bloorview, CSI was asked to identify priority
projects (critical path) that must be pursued by the organization. The following identifies 15 key projects,
ordered by the consultant’s view of the degree of difficulty to pursuing and successfully implementing the
recommendations (8 Low to Low-Medium, 2 Medium, 4 Medium-High, and 1 High). These critical path
projects do not reduce the importance of all 35 recommendations listed, but help to present a focused view
of the immediate work ahead, and help to identify priorities for investment and effort.
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Develop Education Package for Referring Providers (Low);
Develop Tools to Respond to Family Calls (Low);
Develop Scripts to Better Communicate with Family the Impact of Missed Appointments (Low);
Eliminate the Need for a Two-Step Process to Attend External Visits (Low);
Implement Shortcall Appointments for Selected Demonstration Clinics (Low);
Develop a Script to Enhance Family Communication Regarding Interpreter Usage and the Impact
of a No-Show (Low);
Eliminate Paging for Interpreter Arrival and Notifying Providers Clients Have Arrived (Low-Med);
Develop Improved Statistics and Leverage for Decision Making Processes (Low-Med);
Communicate Referral Receipt with Referring Provider and Scheduled Appointment with
Referring Provider and Client Family (Med);
Implement New Process to Reconfirm Interpreter Requirements for Subsequent Visits (Med);
Implement an Electronic Referral and Intake to Eliminate Paper Communications (Med-High);
Implement Processes to Initiate Scheduling of a Clients Next Visit Before they Leave (Med-High);
Investigate and Implement Different More Cost-Effective Interpreter Models (Med-High).
Leverage Meditech Primary Scheduling System Eliminating the Need for an Excel Spreadsheet
(Med-High); and
Implement Policies to Ensure Provide Schedules are Up to Date and Accurate (High).
To enable moving forward, Holland Bloorview should leverage rapid redesign tools that can be completed
enabling early traction and success; build on existing work underway; address change management areas
where political pushback is expected early; and make necessary investments to support technological
advances.
Eliminating Barriers to Access: Creating New Roads to Care - A Plan to Enhance Urban Telepsychiatry
CSI Consultancy Inc. © 2014
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