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The
High Performance Clinical Office
Through
application of principles deriving from the Institute for
Healthcare Improvement's
Idealized
Design of the Clinical Office Practice Collaborative
Long waiting times for
routine appointments, long patient clinical cycle times, constantly
missing charts, long collection times (or none at all), employee
turnover, thinner margins, unsatisfactory HEDIS indicators, time
pressures…
“Hassled, Harried
and Hurried.”
That is one physician’s
description of his life as a clinician. He spoke for many, many others.
Unfortunately, it is not unusual these days for the typical physician in
clinical practice to feel this way. On top of it, margins are declining
along with patient satisfaction.
Is high performance of the
clinical office practice possible?
Much in medicine is
discouraging. Time pressure, complexity and inefficiency have degraded
performance and satisfaction for patients and staff alike with increased
waiting times and receivables.
However, there are
exciting design concepts developing on the horizon and even now becoming
available. These have the potential to significantly, even strikingly,
improve the performance of the clinical office.
It is widely acknowledged
that there is substantial waste and unnecessary complexity in medical
care, both from imposed processes and procedures but also from within
the practice due to the habits and mental models of the way
practices are traditionally designed. Clinical practice design has
generally followed historical and time honored methods to achieve what
was believed to be on-going improvements. Often the approach of
continuous improvement is excellent strategy and can result in
meaningful continuous improvement results over time. But at times the
paradigm or model must be fundamentally redesigned to accomplish the
breakthrough improvements we really want and need today.
Hope
There
are several breakthrough strategies, such as lean thinking, that, when
combined in the clinical setting, result in a
dramatically different performance profile for a practice, be it
specialty or primary care. Many of these are originating from work being
done by participants in the Institute for Health Care Improvement’s
collaborative in the Idealized Design of the Clinical Office Practice.
Several are based on lessons learned in industry concerning efficient
quality production.
Many of these strategies
can be implemented by the willing clinical practice:
Open/advanced
access with virtually no waiting time for any appointment, based
on truly understanding the demand pattern created from the clinic’s
patient panel and redesigning the appointing system. Unbelievable? It
is being done at hundreds of sites already,
Streamlined patient flow, reducing significantly the waiting times
and patient cycle time within the clinic and improving clinic
efficiency and productivity,
Master
scheduling – matching capacity to demand to level the flow and
anticipate the demand,
Enhanced
patient-provider communication,
Use of clinical
decision support technologies such as the Problem Knowledge
Coupler* (PKC) to speed and enhance the diagnostic process and
subsequent treatment decisions,
Proactive management of the clinic’s patient panel’s health
through the use of in-office registries to reduce morbidity, intensity
of care, and costs,
The wise
use of technology to streamline office processes,
and many more…
We also can show how to
significantly shorten laboratory cycle times and other clinical supporting
services using the principles of lean thinking.
Interested?
Our consulting group
is in the business of assisting clinics in achieving breakthrough
performance.
* The PKC, or
Problem Knowledge Coupler was created by Dr. Larry Weed and is a
product of PKC, Inc. It is an electronic clinical decision improvement or support tool, it is neither algorithm, guideline-based, nor expert system
(in
the usual sense of the word) and is designed to non-coercively facilitate physician
knowledge and judgment. Unlike algorithms, it handles multiple
diagnoses with ease.
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