IMPROVING OUTPATIENT ACCESS AND INCREASE PROVIDER PRODUCTIVITY BY

REVIEW APPOINTMENT SYSTEM IN HARAMAYA GENERAL HOSPITAL

2016 EFY

Prepared by Harif A(M.Sc)

 Introduction
◦ Hospital settings create challenges for outpatients care services. Accessing the care needed is critical
for these patients to achieve optimal health outcomes. Delays in treatment can result in irreversible
disease progression and even, exacerbate the cost of care for both the patient and the health system.
Patient appointment scheduling, staff scheduling, allocation of equipment and resources, and
decisions about how to interface with the rest of the health care system each have their own nuances
in an OPC setting.
The challenge of balancing the interests of patients with those of healthcare providers is increased
when patients fail to show up for scheduled appointments. Overbooking appointments mitigates the
lost productivity caused by no-shows but increases patient wait time and provider
overtime.
 Cont..
◦ Missed appointments may compromise patient safety, medication adherence, patient education, patient
treatment, and overall quality of care. Furthermore, missed appointments may adversely affect patient care
when patients are not monitored in managing their chronic condition, increase rates of emergency
department (ED) or urgent care visits and result in more hospitalizations costly to a healthcare provider’s
practice as evidenced by reduced revenue.

Offering sufficient access to healthcare services can present numerous challenges, especially in the arenas
of availability, convenience, and affordability.

◦ The purpose of these project is To deliver a specialist opinion to support the diagnosis and management
of conditions, or oversee management in more complex patients, preventing admissions.by making pre-
appointment reminder are made and rescheduling within a week.
 Problem of statement
In our hospital There are problems found in appointment attendance and Outpatient
services which include: Long queues at Hospital's reception desk, long waiting time
at outpatient services, A waste of valuable resources Patients who miss
appointments have poorer health outcomes and increase costs for medical care,
Unordered appointment schedules due to lack of coordination between various

source of appointment booking. Frustration for customers, patients and staff,

 Aim of the statement
◦ The aim of the project is to review and improve the outpatient service for specialty
clinics in order to improve processes and quality of service whilst meeting key

recommendations, and decreasing the annual revenue loss at the end of 2023
 Project objectives
◦ To establish demand and capacity for clinics
◦ To review the patient pathway in order to reduce delays
◦ To review access and booking processes
◦ To review current ways of working
◦ To review clinical pathway criteria and discharge protocols
◦ To improve access to diagnostics
◦ To improve provision of tests and diagnostics from primary care
◦ To improve the patient experience
◦ To pilot changes in service and evaluate for wider implementation
What to be improve in access of outpatient healthcare service
Methodologies of the project
Model for Improvement
What are we trying to accomplish?

What change can we make that will

result in improvement?
How will we know that a change
is an improvement?

Act Plan

Study Do
 Fishbone Diagram
People/staff
Inadequate
Shortage of clinicians Policies and standard
knowledge
& training of Poor communication
workforce No standard for appointment
and poorly managed
No value based care
Absence of patient flow
employee Poor medical literacy No scheduled process
of engagement Shortage of hospital budget
$$
Improving Patient Access to
Inappropriate hospital Healthcare on specialty clinic
size with services Cost burden Poor mgt, Rx and Dx
of disease
unnecessary referrals to specialists
Poor documentation of
Lack of transportation Difficulty in rescheduling
Long waiting time

Lack of remainder system and Absence of specialty clinic always

inappropriate use of technology

Environment/technology/ Services delivery

 Aim Primary Drivers Secondary Drivers Change Ideas
By what, by when What must be present to achieve our aim1 What must be present to deliver each
driver Develop guidelines for booking for follow
up patient, rescheduling guidelines, ensure
relevant policyis updated
Determine current demand on
service
prepare booking system that agree with clinicals and
ensure compliance with choose and booking criteria
Improve demand and capacity
Review booking process for both new patient and follow up patient,,
capacity within the service for
explore alternative to outpatient appointment
named clinicians

Review way patients attend for test for new and FU

To improve patient experience and
reduce waste Review current pathway and alternatives to
outpatient appointments,
Improve clinical pathways Review current referral process and current
booking process.
and one-stop outpatient To work up criteria for referral
service and Develop referral, diagnostic and
discharge discharge criteria
hospital performance

Collect data - clinical case mix and outcomes

Review of follow ups
Determine current practice Process Map patient journey and compare
testing with pathway

Improve Clinic observation and Set up patient satisfaction review and

Data analysis
redesign patient access to healthcare
improve patient centeredness
approach Being aware of comorbidities,
Flexible end to treatment pathway,
Prepare patient navigators and remainder of
appointment booking,
Prepare patient support and education groups
 Select Desired Outcome
❖ Toincrease physician and patient satisfaction by proper
appointment.
❖Decrease work load in medical record department.
❖Decrease Unexpected Patients Coming To OPD.
❖To provide opportunity for other patient to get
appointment
❖To create smooth appointment process
 PDSA plan
Milestone
Project Work Initiative/
Actions/Progress Milestone/Outcome Date /
stream Improvement
outcom
Determine current
Carry out Demand & Capacity work for each clinic
demand on service Report on demand
Review clinic templates
Demand and and capacity and capacity to
Develop Models for individual consultants
Capacity within the service help determine
Review room usage at both sites
for named service redesign
Review alternative venues for clinics
clinicians
Clinic Collect data - clinical case mix and outcomes Report on
observation Determine current Review of follow ups observation to help
and practice Process Map patient journey and compare with determine service
Data analysis pathway redesign
Review current pathway
To work up criteria Develop referral, diagnostic and discharge criteria
Pathways and Criteria
Pathways for referral and Review alternatives to outpatient appointments
in place
discharge Review current referral process
Review current booking process
One-stop To improve patient Robust process in
Review way patients attend for test
Outpatient experience and place which
for new and FU
Services reduce waste reduce
 Cont…
Implement service redesign and New service in place
To establish improvement Patient satisfaction complete-
New
new service Set up patient satisfaction review report
service
provision Embed ongoing annual audit in Audit embedded as part of
department annual departmental review

Evaluation complete
Review data Report complete and
To determine
Project Evaluate outcomes presented to appropriate
outcomes of Post Pilot
evaluation Determine satisfaction stakeholders
project
Compile report Examine potential rollout of
changes to other services
 PDSA cycles
Plan Do Study Act

PDS Understand Discussed with GP what the Predictions met. Change in system is Find out more about
A 1 appointment appointment system was like introduction of shorter, pre-bookable day-to-day use of
system in a before, what changes have been ‘review’ appointments. system (observation
meeting with GP. made and the reasons behind and interviews with
the changes. admin staff).

PDS Admin staff Non-participant observation to Facilitators and barriers of the Collect data to see if
A 2 interviews and understand how the appointment system established, administrative staff
non participant appointment system works. opinions on online and review pre- workload has
observation of Admin staff interviews to bookable appointments. decreased as predicted,
the appointment understand their opinions on Flow chart, cause and effect diagram to complement the
system in use. the system. and a driver diagram of the system findings from
made. interviews and
Predictions met—admin staff-like observation periods.
review appointments.
 Cont…
P Collect data on
D administrative staff
S workload. Predictions were
A that workload had
3 decreased.
P Collect data to determine
D whether the intervention
S met patient demand for
A appointments. Prediction
4 was that patient demand is
being met.
Data collected on number Prediction not met —number
of calls received by the of calls remained the same
practice 4 weeks pre- pre-intervention and post-
intervention and 4 weeks intervention. Conducted test
post-intervention to determine statistical
significance of result.
Monday was busiest day.
Run chart created.
Data collected on the Predictions met—patient
percentage (%) of patients demand is close to the target
phoning between 08:00 with 93% of patients
and 09:00 who receive an receiving an appointment
‘on the day’ appointment. when they phone for one
between 08:00 and 09:00.
Collect post-intervention data
on whether patient demand
for appointments is being met
or not.
Collect pre-intervention and
post-intervention data about
clinician workload.
Collect pre-intervention and
post-intervention data about
clinician workload.
 Cont…

PD Collect data on clinician Data collected on the Predictions met—there Collect data on the
SA workload pre-intervention number of appointments was a 43% increase in the clinicians’ opinions on the
5 and post-intervention. available per day pre- number of GP intervention, including the
Prediction was that there intervention and post- appointments available in increased number of GP
was an increase in number intervention, and the weekly the practice. appointments available and
of GP appointments staff rotation of the GPs. shorter consultation time
available. for review appointments.
Do
◦ Test your change ideas one at a time
◦ Use Run chart to monitor your QI project over time.
Study
◦ Describe the measured results and how they compared to the predictions and baseline
Act
◦ Here describe what modifications to the plan will be made for the next cycle from what you learned (Adapt,
Adopt, Abandon)