IMPROVING OUTPATIENT ACCESS AND INCREASE PROVIDER PRODUCTIVITY BY
REVIEW APPOINTMENT SYSTEM IN HARAMAYA GENERAL HOSPITAL
2016 EFY
Prepared by Harif A(M.Sc)
Introduction
◦ Hospital settings create challenges for outpatients care services. Accessing the care needed is critical
for these patients to achieve optimal health outcomes. Delays in treatment can result in irreversible
disease progression and even, exacerbate the cost of care for both the patient and the health system.
Patient appointment scheduling, staff scheduling, allocation of equipment and resources, and
decisions about how to interface with the rest of the health care system each have their own nuances
in an OPC setting.
The challenge of balancing the interests of patients with those of healthcare providers is increased
when patients fail to show up for scheduled appointments. Overbooking appointments mitigates the
lost productivity caused by no-shows but increases patient wait time and provider
overtime.
Cont..
◦ Missed appointments may compromise patient safety, medication adherence, patient education, patient
treatment, and overall quality of care. Furthermore, missed appointments may adversely affect patient care
when patients are not monitored in managing their chronic condition, increase rates of emergency
department (ED) or urgent care visits and result in more hospitalizations costly to a healthcare provider’s
practice as evidenced by reduced revenue.
Offering sufficient access to healthcare services can present numerous challenges, especially in the arenas
of availability, convenience, and affordability.
◦ The purpose of these project is To deliver a specialist opinion to support the diagnosis and management
of conditions, or oversee management in more complex patients, preventing admissions.by making preappointment reminder are made and rescheduling within a week.
Problem of statement
In our hospital There are problems found in appointment attendance and Outpatient
services which include: Long queues at Hospital's reception desk, long waiting time
at outpatient services, A waste of valuable resources Patients who miss
appointments have poorer health outcomes and increase costs for medical care,
Unordered appointment schedules due to lack of coordination between various
source of appointment booking. Frustration for customers, patients and staff,
Aim of the statement
◦ The aim of the project is to review and improve the outpatient service for specialty
clinics in order to improve processes and quality of service whilst meeting key
recommendations, and decreasing the annual revenue loss at the end of 2023
Project objectives
◦ To establish demand and capacity for clinics
◦ To review the patient pathway in order to reduce delays
◦ To review access and booking processes
◦ To review current ways of working
◦ To review clinical pathway criteria and discharge protocols
◦ To improve access to diagnostics
◦ To improve provision of tests and diagnostics from primary care
◦ To improve the patient experience
◦ To pilot changes in service and evaluate for wider implementation
What to be improve in access of outpatient healthcare service
Methodologies of the project
Model for Improvement
What are we trying to accomplish?
What change can we make that will
result in improvement?
How will we know that a change
is an improvement?
Act
Plan
Study
Do
Fishbone Diagram
People/staff
Inadequate
knowledge
& training of
workforce
Policies and standard
Shortage of clinicians
Poor communication
and poorly managed
patient flow
Absence of
employee
of engagement
$$
No standard for appointment
Poor medical literacy
No value based care
No scheduled process
Shortage of hospital budget
Improving Patient Access to
Inappropriate hospital
size with services
Healthcare on specialty clinic
Cost burden
Poor mgt, Rx and Dx
of disease
Poor documentation of
Lack of transportation
Difficulty in rescheduling
Long waiting time
Lack of remainder system and
inappropriate use of technology
Environment/technology/
unnecessary referrals to specialists
Absence of specialty clinic always
Services delivery
Aim
Primary Drivers
Secondary Drivers
By what, by when
What must be present to achieve our aim1
What must be present to deliver each
driver
Determine current demand on
service
Improve demand and capacity
capacity within the service for
named clinicians
Change Ideas
Develop guidelines for booking for follow
up patient, rescheduling guidelines, ensure
relevant policyis updated
prepare booking system that agree with clinicals and
ensure compliance with choose and booking criteria
Review booking process for both new patient and follow up patient,,
explore alternative to outpatient appointment
Review way patients attend for test for new and FU
To improve patient experience and
reduce waste
Improve clinical pathways
and one-stop outpatient
service
To work up criteria for referral
and
discharge
Review current pathway and alternatives to
outpatient appointments,
Review current referral process and current
booking process.
Develop referral, diagnostic and
discharge criteria
hospital performance
Determine current practice
testing
Improve Clinic observation and
Data analysis
improve patient centeredness
approach
Collect data - clinical case mix and outcomes
Review of follow ups
Process Map patient journey and compare
with pathway
Set up patient satisfaction review and
redesign patient access to healthcare
Being aware of comorbidities,
Flexible end to treatment pathway,
Prepare patient navigators and remainder of
appointment booking,
Prepare patient support and education groups
Select Desired Outcome
❖ To
increase physician and patient satisfaction by proper
appointment.
❖Decrease work load in medical record department.
❖Decrease Unexpected Patients Coming To OPD.
❖To provide opportunity for other patient to get
appointment
❖To create smooth appointment process
PDSA plan
Project Work
stream
Initiative/
Improvement
Actions/Progress
Milestone/Outcome
Demand and
Capacity
Determine current
demand on service
and capacity
within the service
for named
clinicians
Carry out Demand & Capacity work for each clinic
Review clinic templates
Develop Models for individual consultants
Review room usage at both sites
Review alternative venues for clinics
Report on demand
and capacity to
help determine
service redesign
Determine current
practice
Collect data - clinical case mix and outcomes
Review of follow ups
Process Map patient journey and compare with
pathway
Report on
observation to help
determine service
redesign
Pathways
To work up criteria
for referral and
discharge
Review current pathway
Develop referral, diagnostic and discharge criteria
Review alternatives to outpatient appointments
Review current referral process
Review current booking process
Pathways and Criteria
in place
One-stop
Outpatient
Services
To improve patient
experience and
reduce waste
Review way patients attend for test
for new and FU
Robust process in
place which
reduce
Clinic
observation
and
Data analysis
Milestone
Date /
outcom
Cont…
New
service
To establish
new service
provision
To determine
Project
outcomes of
evaluation
project
Implement service redesign and
improvement
Set up patient satisfaction review
Embed ongoing annual audit in
department
New service in place
Patient satisfaction completereport
Audit embedded as part of
annual departmental review
Review data
Evaluate outcomes
Determine satisfaction
Compile report
Evaluation complete
Report complete and
presented to appropriate
stakeholders
Examine potential rollout of
changes to other services
Post Pilot
PDSA cycles
Plan
Do
Study
Act
PDS Understand
A 1 appointment
system in a
meeting with GP.
Discussed with GP what the
appointment system was like
before, what changes have been
made and the reasons behind
the changes.
Predictions met. Change in system is Find out more about
introduction of shorter, pre-bookable day-to-day use of
‘review’ appointments.
system (observation
and interviews with
admin staff).
PDS Admin staff
A 2 interviews and
non participant
observation of
the appointment
system in use.
Non-participant observation to
understand how the
appointment system works.
Admin staff interviews to
understand their opinions on
the system.
Facilitators and barriers of the
appointment system established,
opinions on online and review prebookable appointments.
Flow chart, cause and effect diagram
and a driver diagram of the system
made.
Predictions met—admin staff-like
review appointments.
Collect data to see if
administrative staff
workload has
decreased as predicted,
to complement the
findings from
interviews and
observation periods.
Cont…
P
D
S
A
3
Collect data on
administrative staff
workload. Predictions were
that workload had
decreased.
Data collected on number
of calls received by the
practice 4 weeks preintervention and 4 weeks
post-intervention
Prediction not met —number
of calls remained the same
pre-intervention and postintervention. Conducted test
to determine statistical
significance of result.
Monday was busiest day.
Run chart created.
Collect post-intervention data
on whether patient demand
for appointments is being met
or not.
Collect pre-intervention and
post-intervention data about
clinician workload.
P
D
S
A
4
Collect data to determine
whether the intervention
met patient demand for
appointments. Prediction
was that patient demand is
being met.
Data collected on the
percentage (%) of patients
phoning between 08:00
and 09:00 who receive an
‘on the day’ appointment.
Predictions met—patient
demand is close to the target
with 93% of patients
receiving an appointment
when they phone for one
between 08:00 and 09:00.
Collect pre-intervention and
post-intervention data about
clinician workload.
Cont…
PD
SA
5
Collect data on clinician
workload pre-intervention
and post-intervention.
Prediction was that there
was an increase in number
of GP appointments
available.
Data collected on the
number of appointments
available per day preintervention and postintervention, and the weekly
staff rotation of the GPs.
Predictions met—there
was a 43% increase in the
number of GP
appointments available in
the practice.
Collect data on the
clinicians’ opinions on the
intervention, including the
increased number of GP
appointments available and
shorter consultation time
for review appointments.
Do
◦ Test your change ideas one at a time
◦ Use Run chart to monitor your QI project over time.
Study
◦ Describe the measured results and how they compared to the predictions and baseline
Act
◦ Here describe what modifications to the plan will be made for the next cycle from what you learned (Adapt,
Adopt, Abandon)