The Impact of Improving Clinic Flow
There are over 236,000 offices of physician practices in the U.S., with outpatient growth projected at 17% over the next five years. Outpatient volume has grown by 33.6% – with over one billion office visits.1
Today’s healthcare landscape has more options for patients than ever before. While quality of care and the reputation of the physician and healthcare organization are the top influencers of patient choice, additional factors are impacting the overall decision making process. Factors such as appointment availability, perceived wait times and facility location all play a role.2
Healthcare leaders and caregivers alike must look for ways to maintain the highest quality of care for their patients, while uncovering ways to improve the overall patient experience in order to remain competitive in the market and drive financial success.
It’s been no secret that one of the key components to driving improvements lies within the walls of their own facilities – improving clinic flow. By understanding clinic flow, facilities are able to drastically improve operational efficiency, reduce patient wait times and uncover care capacity that was otherwise unknown. This increase in capacity improves patient access, generating additional revenue for the facility.
Utilizing Technology to Uncover Opportunity
Implementing technology can be an invaluable tool in understanding and managing flow throughout the clinic, but a thorough review of existing processes is necessary for a smooth launch and ongoing success. To begin the process, some facilities have found benefit in establishing a multidisciplinary team, ensuring collaboration so that overall coordination is improved, not just processes within one specific area.
Improving clinic flow must first begin by understanding the process, identifying bottlenecks and problem areas, establishing system goals and benchmarks based on these findings, and then through small tests of change, continually moving towards these goals.
Understanding Clinic Flow
Tracking the movement of patients from check-in to check-out is important in identifying bottlenecks, and ultimately their root causes. Prior to technology, this may have involved grabbing a clipboard and walking through the facility as though you were a patient, taking detailed notes about your entire visit – your experience, observations and impressions. Layered on top, it may have included a stopwatch to measure and chart various stages, including how long you spent with nurses and providers.
Today, this process can be automated through the use of location-based intelligence. Using a real-time location system (RTLS) and patient flow software, patient locations can be pinpointed throughout each stage of the care cycle. By having the patient simply carry or wear a wireless badge, your team can have live visibility into not only the current location of that patient, but also a variety of metrics that document the time spent in each care milestone:
- How long the patient waited in the waiting room
- How long the patient waited in the exam room
- How long the patient was with the nurse
- How long the patient was with the provider
Total cycle time can then be calculated, as well as the amount of value-added time (provider facing) versus non-value added time (waiting). Through map replay views, staff can see the exact path patients took through their visits. These tools provide the data and intelligence to identify bottlenecks as patients move throughout the facility.
Staff Workflow and Care Coordination
How much time are caregivers spending with patients? Are there interruptions that are pulling them out of the room and disrupting care? How much time are they spending determining the current status of a patient? How much variation is there in care templates between providers?
Utilizing patient tracking technology, the overall quality of care, staff effectiveness and overall efficiency can be improved. With this technology, the start or completion of care milestones is automatically determined by members of the care team entering or leaving certain types of locations, such as patient care rooms or lab areas. The completion of one milestone can automatically trigger another without delay. Staff have an at-a-glance view of any patient’s location, status and how long they’ve been in that status.
Communication between departments and care team members can be done with automated alerts and notifications instead of manual processes.
- Patients can be located in the facility at any time
- Notifications can be set to alert caregivers when patients have waited beyond a pre-defined standard
- Clinic directors can receive reports showing the number of patients treated by selected physicians, the time it took, the type of appointment, etc.
Careful staff consideration must come into play when technology is leveraged to improve the flow in your clinic. It is important to reassure staff that the technology is being used to improve care, not to monitor productivity. Utilize reports at the start of shifts or during huddles to help the care team understand improvement goals. Empower staff to review patient volumes and cycle time trends to proactively plan for anticipated spikes in volume. Staff adoption is critical in the implementation of any new technology or any change in process.
Exam Room Utilization and Facility Design
How many exam rooms do you have per physician? What is the utilization of those rooms and the variance between peak- and low-volume days? How much time do patients spend waiting in the waiting room versus the exam room? Understanding exam room utilization can lead to a growth in appointment availability, as well as decisions that can impact facility footprint and layout.
Location-based technology solutions can give managers automatic insight into how many exam rooms are being utilized for care delivery throughout any given day. Daily patterns of occupancy can be easily identified, including the amount of time patients are spending waiting in the exam room versus the amount of time patients are spending with caregivers in the exam room (value-added time). Understanding this data can lead to improved utilization of exam rooms, as well as reconfiguration of space to accommodate additional providers and increased volume.
The Impact of Improved Clinic Flow
Improved Staff Efficiency and Satisfaction
Ongoing visibility into the location and status of nurses and providers allows managers to have an accurate, unbiased and up-to-date view into the care process. Outliers and bottlenecks can be easily identified, leading to more efficient workflows and better provider templates. Caregivers will spend more time with patients, and non-value added time will be minimized. Improvements in efficiency allow staff to complete necessary documentation during their shift and leave work on time. As a result, staff will be more satisfied.
Reduced Patient Wait Times, Increased Patient Throughput and Improved Patient Access
Similar to staff, understanding each patient’s journey throughout the care continuum leads to the identification of steps that are causing delays in care. Caregivers will have at-a-glance insight into each patient’s experience – their location, how long they’ve been waiting and who is ready to be seen next. Patients will move in and out of the clinic faster – reducing average cycle time and creating additional capacity to see more patients. This allows the clinic to increase appointment availability, improving patient access and driving increased revenue.
Greater Patient Satisfaction
Patients will be able to get into the clinic sooner due to greater patient access. Patients will get in and out of the clinic faster due to improved efficiency and reduced cycle times. Patients will spend more time with their caregivers and less time waiting – whether in the waiting room or exam room. The less time patients spend waiting the more likely they are to report higher levels of satisfaction.3
A Culture of Continuous Improvement
Using key performance indicators and baseline metrics, data can be continually collected and compared to track improvements in performance to inform important decisions like right-sized staffing models and optimal exam room-to-provider ratios. Maintaining transparency with the team is an important step – sharing outcomes and results with staff builds ownership and accountability. This can be accomplished via huddles, emails, or view boards, which will help foster collaboration and motivation for continued performance improvement. Best practices learned through the implementation of location-based technology can then be leveraged in other departments or locations throughout the healthcare organization.
3Anesthesia & Analgesia, 1998