“Lean” methodology is used for any quality improvement effort in registration areas at Kaleida Health in Buffalo, NY, reports Diane Pazderski, RN, director of patient access services.
“Most of this is not rocket science,” Pazderski says. “It involves looking at a process step by step.”
Three questions are asked: Who does what? Why do we do it the way we do? Where is the opportunity to reduce waste?
Patient access departments easily can become overwhelmed with a project using lean principles, however. At Louisville, KY-based Baptist Health, “oftentimes, simply investigating one issue will give you 10 more opportunities,” says Myndall V. Coffman, MBA, system director of patient access and scheduling. For example, if you are working with the radiology department to streamline the MRI precertification process, you’ll likely discover a few ways to improve other processes.
“Before you know it, the project keeps growing, and nothing ever gets finalized,” says Coffman. “Staying focused on the current process ensures closure.”
Top areas of waste
Lean methodology focuses on identifying “waste” in processes.
“Patient access should never cause a bottleneck for a hospital,” says Coffman. Here are some examples that Baptist Health’s patient access leaders identified in registration areas:
Rework.
“This is one of the main types of waste in access. The do-overs include re-verifying information and correcting errors,” says Coffman.
Transportation.
“Many times, hospitals are very spread out,” says Coffman. “Patient access departments often utilize too many FTE resources with decentralized registration.”
This situation is one form of waste. Another involves patients getting from one area to the next. Patients who aren’t ambulatory might need to go to a centralized area for registration, then travel farther to their area of service.
“Streamlining pre-registration processes and using online options, kiosks, and phone call services are some ways to facilitate improvement in this area,” says Coffman.
Computer systems.
“We are in the process of switching to an integrated system,” reports Coffman. “This will offer several opportunities to improve processes that have not been possible until this point.”
Currently, patient access staff use eight systems to get their jobs done. “Ensuring that staff have one system, with consolidated forms, is very important,” says Coffman.
Single call is made
Recently, Baptist Health Lexington (KY)’s central scheduling department used lean methodology to switch to a “one-call” process.
“We believe that customer care starts at the time of scheduling,” says Ruth A. Patterson, manager of patient access and scheduling. Patients are scheduled, pre-registered, and informed of any copayment they might owe during a single phone call, instead of being called multiple times.
“Efficiently scheduling and pre-registering the patient in advance decreases the department’s abandon call rate and eliminates billing errors,” says Patterson.
Before the “one-call” process was implemented, physician offices waited three to five minutes for the next available agent. They now fax orders without calling. “We contact the patient to schedule, pre-register, and inform them of any copayment they may owe,” says Patterson. “The average hold time in the department now is less than one minute.”
Approximately 300 orders are faxed every week. “This allows us to ensure the order is received up front,” says Coffman. “We contact the patient only one time, and we schedule without tying up the phone lines.”
Previously, schedulers often scrambled to obtain a compliant order the day before a patient’s procedure. Now 100% of scheduled procedures have the order in advance. “Having a compliant order is the key to eliminating billing denials,” says Patterson. (See related story on targeting claims denials using lean methodology, below.)
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Myndall V. Coffman, MBA, System Director, Patient Access and Scheduling, Baptist Health, Louisville, KY. Phone: (859) 260-2162. Email: [email protected].
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Diane Pazderski, RN, Director, Patient Access Services, Kaleida Health, Buffalo, NY. Phone: (716) 859-8399. Fax: (716) 859-8655. Email: [email protected].
