Quality Center Update
A Transformation in Patient Scheduling
In a depressed economy, it becomes critical for hospital systems to increase revenue and decrease costs while improving quality of care. This is why Oak Brook, Ill.-based Advocate Health Care launched the Performance Enhancement division. This systemwide transformation is unique because it empowers front-line associates to challenge current practices and implement improvements where necessary. It is successful because it has the support of leadership.
At Advocate South Suburban Hospital, the outpatient service line, which includes diagnostic imaging, is one of the largest revenue-generating profit centers in the hospital. Besides the emergency department, outpatient services is considered the "other front door" to the hospital. Although it produces more than $50 million in gross revenue, hospital leaders recognized they had an opportunity to improve quality of care, and patient and employee satisfaction—and at the same time enhance growth and revenue to offset reductions of inpatient volume and revenue losses because of the bad economy. In preparation for large-scale transformation, the Performance Enhancement division identified the heartbeat of the center—patient scheduling.
The primary transformation goal was to improve overall efficiency and maximize outpatient volume with existing resources without compromising patient safety and satisfaction. It was critical to create adequate processes to accommodate all demand capabilities. The goal was to increase the number of scheduled appointments versus spontaneous walk-in visits in order to appropriately manage capacity and demand and to ensure that staffing resources were matched to volume. Redesigning patient scheduling was essential to support the large-scale transformation of the outpatient service line.
Baseline State
Patient scheduling operated as a stand-alone operation that was oblivious to the significant impact it had on patient flow through the hospital. The division realized that patient scheduling hours did not match demand because of the extensive patient backlog lists and high percentage of abandoned calls. The schedulers' tasks were not specific to scheduling; they provided a plethora of services that impacted their productivity and the ability to schedule patients efficiently. On average, schedulers spent more than nine hours of an 11-hour day doing non-scheduling and non-value-added tasks.
Improvement and Impact
The Performance Enhancement division implemented a mixed-method process improvement that includes lean, Six Sigma and Change Acceleration Process. A true centralized patient scheduling process was created that resulted in a:
- 90 percent reduction in non-valued-added tasks and responsibilities
- 28 percent increase in outpatient appointments
- Less than 50 percent reduction in scheduler's call length
- 25 percent reduction in abandoned or missed calls.
Thanks to the streamlined workflow, the department converted to an "all green" process, saving money in supply costs such as copy paper, forms and printing fees. The scheduling department expanded its hours of operation to capture new patients and instituted a reminder system to reduce the number of missed and no-show appointments and to recover rescheduled appointments.
Conclusion
As a result of eliminating waste, standardizing processes and streamlining non-value-added activities in the newly designed centralized scheduling department, the outpatient service line was significantly impacted. It is projected to have greater than a 10 percent increase in new patient volume (annualized ROI projected at greater than $1.5 million) at the end of 2009. The revenue projection of $77,600 a month for new patients has been realized and sustained.
Airica Steed, R.N., is administrator of organizational effectiveness at Advocate Condell Medical Center in Libertyville, Ill. Contributing author Lorraine Saintus is an operational excellence consultant. Visit the AHA Quality Center at www.hpoe.org to explore these and other topics.
This article 1st appeared in the November 2009 issue of HHN Magazine.
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