Resources needed

Private Practice Case Study

Background Summary:

A family medicine practice with a history of over two decades at the same location has nearly 8,700 patients and a full team of practitioners and support staff, including aMedical Doctor (MD), aPhysician's Assistant (PA), twoMedical Assistants(MA),Office Managers, andClerks. Despite having well-experienced employees, the practice faces several challenges, such as data integrity issues in its recently implemented electronic health record (EHR). As aLean Six Sigma consultant,you were called in and confirmed several data management issues and also noticed process efficiency and possibly organizational culture problems. You observed that the First-Time Process Yield (doing things right the first time in the eyes of the customer) was 35% on average.

Below is a summary of your findings the other day--"A Really, Really Bad Day at the Office..."

Anyyellow highlights sectionsare issues that affect thepatient. Anybolded textrepresents thejob titlesof those working in the practice.

1. One of the two MAs came in to find a packed schedule ofback-to-back new patients. The day worsened as the otherMAcalled in sick, and theMDwas late, causing delays from the start.
2. Thefirst patient was kept waitingdue to theMD'sdelay, while anotherpatientwithout an appointment becamevisibly unhappy with the waitand was allowed to skip ahead in line, frustrating otherwaitingpatientseven more.
3. The soloMAwas so busy that he forgot to furnish supplies to one room and missed recording the vitals of two patients. His day became even worse when he made a near-miss error while taking a patient's x-ray, resulting in severe reprimands from theMD,thePA,and theoffice Manager.
4. TheMD'sstress levels increased throughout the day due to thegrowing patient backlog. With an essential lunch meeting, theMDhad toleave some patientsto thePA,risking further complaints. He even made an incorrect EHR entry andnearly prescribed the wrong medication to apatientin the EHR Computerized Physician Order Entry (CPOE) system.
5. TheCheck-Out Clerk,who was emotionally distracted by personal issues to begin with, facedcomplaints from multiple patientsfor extended waiting and ended up makingan errorin the patient's referral.
6. Alongside the criticism from theMDover the day's disorganization, theOffice Managerwas stressed from juggling multiple problems, including wrong deliveries, staff-related concerns, and patient complaints.
7. TheRevenue Cycle Management Clerkencountered a number of documentation deficiencies, which complicated accurate coding and often led to down-coding to avoid insurance denials.
8. The tiring day ended late, leaving thestafffatigued and discontented. Both theMAand thePAconsidered leaving their positions at the practice.
9. TheMD,in turn, contemplated joining an accountable care organization, though she was hesitant about losing her independence. An accountable care organization (ACO) is a healthcare organization that brings together a group of coordinated healthcare practitioners, such as doctors, hospitals, and other providers, to deliver high-quality and coordinated care to a designated group of patients.
10. Patients were also very unhappy due to poor service and excessive wait times.

Over the past week, you have observed the following 14 steps and average durations that a typical patient experiences at this practice:

1. Arrival and check-in:

Duration:15 minutes

The patient spends time waiting in line, searching for necessary documents, and handling paperwork provided by the receptionist.

1. Filling out paperwork:

Duration:25 minutes

Due to unclear instructions or lengthy forms, the patient takes an extended time to fill out or update their information.

1. Additional waiting to get into an exam room after filling out the paperwork:

Duration:45 minutes

The waiting area is crowded, and the office is running behind schedule, resulting in a prolonged queue time.

1. The patient is moved to the exam room:

Duration:1 minute

1. Additional Waiting time in the exam room before anyone comes in to see the patient:

Duration:30 minutes

1. Patient's vitals taken in the exam room:

Duration:10 minutes

The MAs are juggling multiple tasks and are not immediately available. When they do arrive, the equipment might need recalibration or temporarily be nonfunctional, necessitating some of the vitals to be taken manually.

1. Additional waiting for the MD or PA to come into the exam room to see the patient:

Duration:20 minutes

The MD is backed up and is distracted with phone calls, paperwork, and meetings.

1. Patient consultation with the MD or PA in the exam room:

Duration:10 minutes

The MD and the PA are so swamped, and it takes them a while to get to each examination room. The actual consultation is rushed but still takes longer than usual due to disorganization.

1. Waiting for additional tests or procedures on the same day at the office visit (if necessary):

Duration:30 minutes

The lab or X-ray room is busy. There's also some waiting involved before the technician is available. The delay may be due to the equipment needing adjustments or a backlog from uncleared old records.

1. Actual additional test time (if necessary):

Duration:10 minutes

1. Waiting in the exam room for the MD or PA after additional tests:

Duration:10 minutes

1. Receiving prescriptions from the MD or PA:

Duration:10 minutes

The system is slow, or the practitioner takes time searching for prescription details or handling a backlog of prescriptions in the CPOE system.

1. Check-out and scheduling follow-up appointments, tests, and referrals to other specialists:

Duration:10 minutes

The reception area is crowded, the computer system is lagging, or the staff is trying to manage multiple tasks at once. Scheduling is further delayed if the system freezes intermittently as a result of overdue updates.

1. The patient leaves the practice and drives to the pharmacy to get their prescriptions filled.

1. The patient has access to lab test results after leaving the office:

Wait Time:14 days after their office visit

Due to backlog and inefficiencies, test results that should be available sooner take longer to process.