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By Diana Smith
Seton Healthcare Network Heartbeat
Volume 13, Issue 2 - February 2006

“Do the hustle,” has taken on a whole new meaning for Seton McCarthy Community Health Center staff. A multi-disciplinary team has taken the 70s dance theme, turned it into a dynamic motto for improving patient care, and as a result, has increased customer satisfaction. In fact, the motivational idea has led to the implementation of a new customer service initiative that has improved patient satisfaction and Worklife Community.

Launched in spring 2005, the “Seton McCarthy Hustle” is a team-driven initiative to reduce patient wait times and improve efficiencies without reducing quality of care at the health center.

“The patient cycle times (from moment of entry to leaving the clinic) were sometimes 90 minutes or more,” says Jim Thomas, Director, Community Health Centers. “Our team really stepped up and found ways to reduce these times.”

Open since 1989, Seton McCarthy provides a wide array of health services to community residents in East Austin as well as to uninsured patients, and Medicare and Medicaid patients. In addition to medical care, services include diabetes education, laboratory services, nutrition, counseling, social work services, prescription assistance programs and the book give-away program—Reach Out and Read. The center serves as a medical home to more than 4,700 persons each year and provides more than 11,000 visits annually.

Good Care, But Waits Too Long

“We knew from customer satisfaction surveys that patients were very happy with their medical care at Seton McCarthy,” says Lupe Trevino, administrative supervisor. “Yet, they often commented on the time it took to see a provider.”

Seton McCarthy decided to tackle the issue head-on and purposely selected a team comprised of providers and frontline representatives, without senior level staff. Upon receiving a grant to fund a time study, Seton McCarthy’s five-member team, including Trevino, Dr. Melissa Smith, family practitioner and lead physician; Maria Marek, RN; Susan Nash, Social Worker; and Dan Ramirez, Medical Assistant, went to work.

Mapping Patient Visits

“After initial training, we began with a time study of the clinic,” reports Marek. “We mapped patients from two different angles, from their perspective and from a staff perspective. We followed the path different patients would take and timed how long it took on each step from the moment they walked in the door until they left. We did 10 different mappings. It actually was pretty intense.” According to Trevino, team members actually followed the patient from the time they entered the door to discharge. “We put ourselves in the patients’ shoes and went with them from the waiting area, to lab, to the exam rooms, wherever they had to go. We found it to be exhausting from the patient’s perspective. Even if you were waiting only five minutes, the perception was longer because you sit there hearing the clock tick.”

The mapping process broke down a patient’s visit into specific tangibles. Marek adds, “We looked for things like ‘how did people get notified?’ ‘When did charts get moved?’ ‘How long did it take to see the doctor?’”

According to Marek and Trevino, the mapping process enlightened the team. Some patients had up to five handoffs between staff members and seven different stops for their one clinic visit.

“Surprisingly, we weren't getting hung up where we traditionally thought there would be problems,” says Marek. “We thought the more complicated cases or patients with many needs took the longest. That actually wasn't the case. We knew many of those patients and knew what to do for them.” She adds that it was the unexpected day-to-day details that caused delays. For example, a patient would come to the clinic from a specialist and Seton McCarthy wouldn't have paperwork that was needed and would have to call. Or a patient would be seated in an exam room with one medical problem, but tell the doctor about something else, for example, a sore throat. That would mean the doctor would have to leave, find a nurse to do a swab, then wait for those test results.

“Mapping gave us a real perspective of what was going on with patients,” explains Trevino. “It woke everyone up to what was reality, and we had facts to back it up.”

Redesigning the Patient Visit Process

The good news was that such extensive mapping showed the team specific areas that could be improved. The team set an ambitious goal to reduce cycle times significantly, from more than 90 minutes to 45. They developed new patient visit models and redesigned the patient visit process.

That included using the 12 Principles of Redesign™, as directed by Pat Pickering, the trainer from Coleman Associates. Key actions the team looked at included communication between the front office and the first point of contact for the patient, and the back, where clinical staff worked and number of patient contacts. The team tested five models, found the right one and gradually introduced it to different providers and staff.

“We straddled both working the new way and working the old way for three to four months,” says Marek. “It wasn't an easy process to change, but we finally got to the point where we did it all the time.”

Communication is Key

One of the biggest changes, report Marek and Trevino, is in communication. Often, a front desk member would have to leave to find a provider and relay some key information. Now, the front staff and clinical personnel communicate by walkie talkie. “It's made a huge difference,” says Trevino.

Marek concurs, “When we started using walkie talkies, it connected the front desk to us. As soon as a patient hit the door, we knew what was happening.” Nurses and Clinical Associates could better prepare, knowing what tests or supplies were needed, or if a translator should be found. “We wasted a lot of time just looking for each other,” explains Marek. “Now, the Client Services Representative is in communication constantly with the nurse and CA, where before they would have to walk back or pick up a phone.”

Dramatic Results

While final details are still being implemented, results of the “McCarthy Hustle” showed almost immediately, according to Trevino and Marek. In only the first few months, cycle times decreased significantly, and now six months after implementation of the model, cycle times are at less than one hour. Patients are happier, and customer satisfaction surveys rarely mention time delays, says Trevino.

The model has been extended to include more providers at the Center, with the goal to include all. For patients, it has resulted in much less wait time, plus more flexibility in scheduling. Staff morale is higher, too, says Marek. Providers, nurses and staff now finish on time, have more time for paperwork and have more control of their schedules.

In addition, the initiative has increased the ability of the center to see one to two more patients per day, thereby increasing revenue. That led to a presentation before the Leadership Team. Recently approved for six months, the result is that a new nurse will be added to the staff to handle patient overflow. “Seton McCarthy used to have the longest cycle times of all our SETON clinics,” says Marek. “Now, we are consistently coming in with the shortest.”