I wanted to let you know how much of an impact your actions and wisdom had on a small community health center in Nebraska where I work. It has been really struggling for quite a while: providers are unhappy with the number of no-shows, receptionists are drowned in phone calls, front desk staff are generally blamed for the failure of the clinic, patients are jammed in the waiting room and can’t reach us by phone so they leave tons of messages, and MAs are overwhelmed with phone calls and overbooks. On February 28, 20 people were laid off and others had their hours and benefits reduced.

The week after I returned from the California Rapid DPI, I was determined to not go back to the way things were. Because of the great work you all did [Coleman Associates staff], I was inspired to catapult the changes needed to keep my clinic open. I had a serious sit down with the right authority figures, who were at their wits’ end and said, “We’ll try anything at this point!”

I started by re-reading the articles on the Patient Visit Redesign website [patientvisitredesign.com], and remembering the lessons I learned in California. Then we went to work over one week to get everything ready to “go live” the following week.

What did we do? We restructured the patient schedule so every clinician had 2-4 same day appointment slots, and we dispensed with almost all of the 30 minute appointments, so we almost have only 15 minute slots. (I”m still negotiating to get ALL 15 minute slots). And, we gave the front desk the “power” to fill empty same-day slots. No more triage! And no more overbooks!

We relocated the phone people to the front desk, in a slightly separate cubby, so they could all see each other, so they would pitch in and help each other when either area would get hit by a surge. We re-routed the phone lines and changed the message so we could answer the phone live most of the time instead of taking messages.

We then re-teamed providers and MAs, and implemented QuickStart [getting each clinic session off to an on-time start], and SoftLandings [making sure each clinic ends on time]. We got rid of the lab schedule, and now each MA has her/his own lab schedule with 2-4 openings per day, which frees up an extra MA [who was nailed down in the lab before], and moves us closer to the Patient Centered Medical Home concept.

We developed a robust reminder call script [an actual “script” staff follow for consistent results], and a money collection script. MAs, front desk, and volunteers have been taught to jockey the schedule and make reminder calls, as well as to check insurance eligibility. Everyone has received the “YES Culture” speech [The easiest route to great patient access is to just say “Yes” to patients, then design systems and processes to support that culture]. And the walls were plastered with dashboards [a visual method for sharing data and promoting a transparent results-oriented culture – see article titled Performance Dashboards: Defining and Creating an Effective Tool for Management.]

Whew! Then the next week, March 14, we went live with everything. My COO and I coached the front and back staff every day. So now, here it is, Friday, March 18, 2011. After an incredible amount of work on the part of a lot of people, as well as a very willing attitude on the part of everyone to try anything suggested, these are the results – in just one week:

• Patients are receiving reminder calls and given the opportunity to reschedule [creating more open slots for patients looking for same-day appointments].
• Providers are exceeding their daily patient quotas.
• Walk-in patients are welcome and only five patients could not be accommodated on the same day and were given appointments for the next day.
• We had been averaging up to $500 per day in uninsured cash collections (on a great day), but this week we are averaging $1850 per day (about $20 per patient). Our goal is $2000/day and we reached it this week!
• We were getting 180 voicemails per day from patients and others. This week, because we are answering the phone “live,” we are averaging around 20 voicemails per day. Our goal is zero voicemails between 8:00-5:00.
• We’ve gone from approximately 67 missed opportunities on a busy day [slots that were open for same days or became open due to no-shows and cancellations], to less than 20. Our goal is zero.
• The staff are happier, the front desk is getting compliments rather than complaints, and the patients thank us for the new “vibe.” (I saw the parking lot half empty for the first time ever on Thursday!) The waiting room is much calmer. There’s no longer a mad rush to get in and “fight” for an appointment.
• Our no-show rate averages 28%, but this week we got it down to 11%, and it stayed there every day.

Other departments (medical records, and case management) asked me to “re-do” their area next. They like how the medical part is working. [This is how change spreads organically!] There are a lot of kinks to work out and not everything works perfectly—but so far, almost everyone is thrilled with the changes and the outcomes.

Thank you! Thank you! Thank you!