Primary Care Case Study

Rethinking Typical Clinic Visit Improves Patient, Physician Satisfaction

Primary care physicians are the first line of defense when it comes to improving patient health. These medical providers and their staff members provide care for everything from infections to chronic conditions, such as diabetes and high blood pressure. It’s a busy job that can lead to burnout not only among providers, but the nurses and other clinicians who work in their offices.

With experts predicting shortages in the number of primary care providers and nurses in the years to come just as the demand for quality care increases, healthcare providers are looking for ways to help employees better manage the workload while still providing high quality care to patients. Using its lean management practices, ThedaCare found a solution to this problem, redesigning how care is provided in primary care clinics.

Background

ThedaCare is a non-profit community health system based in Appleton, Wis., comprised of seven hospitals and 35 clinics in northeast Wisconsin. With nearly 6,100 employees, it is one of the largest local employers and dedicated to delivering world-class care for its patients. Since 2002, ThedaCare has embraced lean management principles to improve the quality of care and while containing costs. The health system took the Toyota Production System model of lean manufacturing and adapted it for healthcare, creating teams of employees and patients to take a hard look at the way ThedaCare was doing things and come up with a better way.

With a wide variety of care provided to patients in a primary care clinic, many medical providers found themselves moving from patient to patient throughout the day and then spending time at night looking at lab results and communicating those results to patients. At the same time, patients were waiting for results, left wondering what the different results would mean.

“When we started back in 2007, satisfaction among employees and patients was mediocre. Our clinicians were working from home at night after a busy day in the office so we looked at the entire clinic visit from how visits were scheduled throughout the visit,” said Jenny Redman-Schell, chief operating officer of ThedaCare Physicians. “One area that we saw could help improve satisfaction was turning around lab results more quickly.”

The Challenge: Long Wait Time for Lab Results

When talking with physicians and nurses, getting patients’ lab results in a timely manner was often a concern. When employees looked at the problem, it wasn’t that it took too long to get test results, but rather it was the speed in which the results were delivered to providers and their medical staffs.

“Providers told us if they had results during a patient’s visit, it would make it more productive since they could discuss what the results were, what they meant, and what steps, if any, needed to be taken,” Redman-Schell said. “Previously, doctors would meet with a patient and say ‘if the labs say this, then we’ll do this,’ and that was confusing for patients. In addition, communicating results to patients after a visit took more time too since they didn’t always connect.”

The average turnaround time for lab results in the clinic setting was 370 minutes and results of routine lab tests, such as cholesterol, were never shared with a patient during his or her doctor visit.

The Solution: Focus on Providing Common Lab Results Quickly to Initiate a Plan of Care Sooner

ThedaCare Physicians-Kimberly, the pilot site for the new process, brought together nurses and physicians using lean management tools to help identify problems and find solutions quickly, while maintaining quality care for patients. Staff members redesigned the entire patient visit so patients could receive their lab results during their appointment.

To make this happen, a small onsite lab was opened at the Kimberly clinic. In addition, staff members looked at patients’ records and identified those needing lab tests.

As soon as the samples were collected, lab staff ran the necessary tests and got the results to the provider so they could be shared with the patient during the visit. The goal was to get results in 15 minutes.

“With providers having the results in hand, they could then immediately share them with the patient and develop a plan of care so the patient knows what to expect and what to do when they leave the office,” Redman-Schell said. “It brings added value to the appointment and patients are able to start more quickly on any steps they may need to take based on the lab results.”

The Results: Faster Lab Turnaround Time Improves Patient, Employee Productivity and Employee Participation

Since 2006 when ThedaCare began changing how core lab tests were administered at its clinics, the percentage of results provided during a patient’s visit went from 0 percent to 63 percent and the average turnaround time for obtaining lab results fell from 370 minutes to 17.

Nearly all patients leave their appointments with a written plan of care.

“There’s less need now to contact patients with results or information about what they need to since they are leaving their appointment with all the information they need,” Redman-Schell said.

Employees and patients both report increased satisfaction with their clinic visits, Redman-Schell added.

What’s Next?

After seeing success in Kimberly, ThedaCare Physicians rolled out the new lab test process to other clinics that were large enough to support an onsite lab. Redman-Schell said employees continue to look at the process and identify ways to make it better.

“Healthcare is always changing and we need to change with it. We constantly review how care is provided to patients in our clinics and want to make sure we are staying on top of changes as they come up,” she said.  “It’s a continuous process and it’s one we keep working on.”