You have just been brought in to manage a portfolio of several specialty clinics in a large multi-physician group practice that is part of the newly formed academic medical center, ECU Pirate Healthcare. The clinics reside in a multi-clinic facility that houses primary care and specialty practices, as well as a satellite laboratory and radiology and pharmacy services. The practice provides the following centralized services for each of its clinics: registration, payer interface (e.g., authorization), and billing. The CEO of the practice has asked you to initially devote your attention to Clinic X to improve its efficiency, patient satisfaction, and no-show rate. The goal no-show rate is <8% monthly.

Patient Access Process

A primary care physician (or member of the office staff), patient, or family member calls the receptionist at Clinic X to request an appointment. If the receptionist is in the middle of helping a patient in person, the caller is asked to hold. The receptionist then asks the caller, " How may I help you?" If the caller is requesting an appointment within the next month, the appointment date and time are made and given verbally to the caller. If the caller asks additional questions, the receptionist provides answers. The caller is then given the toll free preregistration phone number and asked to pre-register before the date of the scheduled appointment. If the requested appointment is beyond a 30-day period, the caller's name and address are put in a "future file" because physician availability is given only one month in advance. Every month, the receptionist reviews the future file and schedules an appointment for each person on the list, and a confirmation is automatically mailed to the caller.

When a patient pre-registers, the financial office is automatically notified and performs the necessary insurance checks and authorizations for the appropriate insurance plan. If the patient does not pre-register, when the patient arrives at the clinic on the day of the appointment and checks in with the specialty clinic receptionist, she is asked to first go to the central registration area to register. Any obvious problems with the authorization are corrected before the patient returns to the specialty clinic waiting room.

Receptionist's Point of View

The receptionist has determined that the best way not to inconvenience the caller is to keep him or her on the phone for the shortest period possible. The receptionist expresses frustration with the fact that there are too many tasks in the office to do at once.

Physician's Point of View

The physician thinks too much of his/her time is spent on paperwork and chasing down authorizations. The physician senses that appointments are always running behind and that patients are frustrated, no matter how nice he/she is to them.

Patient's Point of View

Patients are frustrated when asked to wait in a long line to register, which makes them late for their appointments, and when future appointments are scheduled without their input. As a result of this latter factor, and work or childcare conflicts, patients are often no shows for these scheduled appointments.

Office Nurse's Point of View

The office nurse feels that he is playing catch-up all day long and explaining delays. The office nurse also wishes there was more time for teaching.

Billing Office's Point of View

The billing office thinks that physicians are giving some care that is not reimbursed because of inaccurate or incomplete insurance or demographic information, and observes that some care is denied authorization after the fact.

Patient Satisfaction Measures

All clinics in the multiphysician group contract with a customer satisfaction measurement firm that administers customer surveys. This survey is sent to a random sample of patients at each clinic to determine their ratings for eight dimensions of outpatient care for adults and children.

Performance Data

The last 6 months' worth of performance data for Clinic X are the following:

Overall satisfaction with the visit rated as very good or excellent 82%

Staff courtesy and helpfulness rated as good or excellent 90%

Waiting room time for patients is less than 15 minutes 64%

Examination room waiting time is less than 15 minutes 63%

Patient no-show rate 11.01%

Patient appointment cancellation rate 11%

Provider appointment cancellation rate 10%

Rate of initial insurance claim rejections because of inaccurate or 4%

incomplete patient record documentation

1. Chooseoneof the following problem areas from the case along with theno show rateto devote your attention to. Recall, the goal no-show rate is <8% monthly.
2. Review the following process improvement techniques. Consider the following when presenting your assessment and recommendation. Depending on which problem area you selected, will determine which of the below are most applicable, if any. These are suggestions only.
   1. Eliminate waste (e.g., things that are not used, intermediaries, unnecessary duplication)
   2. Improve workflow (e.g., minimize handoffs, move steps in the process closer together, find and remove bottlenecks, do tasks in parallel, adjust to high and low volumes)
   3. Manage time (e.g., reduce setup time and waiting time)
   4. Manage variation (create standard processes where appropriate)
   5. Design systems to avoid mistakes (use reminders)
3. Using the SBAR template located in Canvas, recommend changes to the CEO of the practice.
4. At the bottom of the SBAR template there is a place for an appendix. Please copy and paste the chart created in the Excel file for this assignment. To construct the chart:
   1. Compute the monthly no-show rate using the data provided. Construct a chart (choose the best type based on the data being displayed) that shows the no-show rate for each month. Your chart should display at minimum, the following:
      1. Monthly no-show rate
      2. Six-month average no-show rate, which you will need to calculate.
      3. Goal no-show rate of 8%

No-Show Rate: Scheduled visits in which the patient did no show up and made no prior contact to cancel their appointment. Calculation Method: Divide total number of scheduled visits missed with no contact by the total number of actual patient visits.

Goal No-Show Rate is <8% monthly.

Data Month	Total Visits Missed w/no Contact	Total Patient Visits	Monthly No-Show Rate	Average No-Show Rate	No -Show Rate Goal
January	68	579
February	76	610
March	44	551
April	53	573
May	60	549
June	89	649