By William Petersen, MD, Katie Fellows, and Teresa Green
What exactly is Ambulatory Optimization?
Ambulatory Optimization is a major effort that is using A3 problem solving to improve our outpatient operations. The goal is to better meet the needs of our patients while increasing operational effectiveness and efficiency.
Why is this important?
Most UVA patients receive their care in the outpatient setting. In 2016, we saw 1.1 million ambulatory visits across more than 300 clinics. Our clinic process designs do not consistently meet our patients’ expectations, and achieve operational efficiency, while supporting the three missions of clinical care, education, and research. The UVA Health System has identified optimization of ambulatory service delivery as the highest system priority.
How does this Health System-wide effort involve Women’s and Children’s?
For us in Women’s and Children’s, we will focus on efforts on making the Battle Building as effective as possible. For the past three years, a shared governance group has met every week. Now, we are working with the Patient Friendly Access Implementation Team, a group of Project Managers with experience in Access Best practices. As a collaborative group, we are able to pull together resources from many functional areas across the Health System.
Do you have a specific goal for Women’s & Children’s?
To provide patient-centered care in an environment where we have clear role delineation, sufficient tools to do our jobs, and where faculty and staff are working to top of their license.
How do you plan to reach this goal?
We will approach this as a two-stage process: 1) PFA and Access Improvements to include the transition of the currently “un-Podded” specialties, and 2) Clinical Operations Optimization. We will be focusing first on stage 1, PFA and Access Improvement, which includes the steps listed below:
- Identify and define ambulatory work, role delineation, standard processes
- Improve provider and team member experience
- Develop seamless integration for referring providers
- Build a supportive environment and collaborative culture
What are you doing now to work towards that goal?
Currently we in the process of the following:
- Call Center Operations restructure
- Offering option 9 (connect to Cyracom Spanish interpreter) available on BIZ phones prior to transitioning to ACC phones
- Communication Pathways work group will follow “Use Cases” to define standard work
- Nurse Triage work group defining current state
- Peds Renal identified as Guided Scheduling pilot
- Transition plan for CH Scheduling Specialist re-design (Northfork PFA Call Center)
Have you completed any work towards the goal?
We have been able to complete several activities towards our goal. They include:
- New Access Associates team members: we have posted eight (8) positions and have four (4) new team members starting in November.
- Completed redesign of call flow and development of Call Center Operations Organizational Structure
- Identified the Access work, who does the work and how the work is done with standard processes and workflows
- Mapped current state, identified gaps between current state and future state and developed Future State-Role Delineation for access work
There are concerns within Women’s & Children’s around access, what is the problem?
The UVA Children’s Hospital patient access infrastructure (processes, staffing, and tools) does not adequately meet the needs of patients, providers, referring providers, clinic staff, or access team members, as evidenced by:
- Existence of work that does not have a designated owner and Lack of Role Delineation between PFA, Clinics, and SOM
- Lack of Standard Work for Access Processes across Children s Hospital Divisions
- Long Lag Times for Incoming Referrals and Lack of Communication on Delays
- High Transfer Rate for Incoming Patient Calls
- Ineffective internal communications between PFA and clinics
If we have questions or want to contribute, how can we get involved?
We will be doing this work through work groups that include Providers, front-line team members in both Clinic Operations and PFA. There are several work groups in process at this time. Please contact William Petersen at wcp3g@ virginia.edu or 434-924-2347 or Teresa Green at TLG8T@virginia.edu or 434-982-1642 for more information.
Hear from the team
William Petersen, MD, Pediatric Hematology-Oncology, Medical Director Children’s Hospital Clinics: “I am continually impressed and happy to see how welcome this effort is. The most appealing aspect for me is how well it fits with our culture of continuous improvement. We always want to get better at what we do. We want to be better as a team. I love this approach because Katie Fellows and her team are helping us in many ways to tackle these issues effectively, including helping us to collect meaningful data. From the data, we can learn how we are really doing and how we can improve operations and ultimately increase patient satisfaction. It’s really cool to see.”
Teresa Green, Children’s Hospital Ambulatory Manager: “I have been so pleased with the organizational commitment and laser focus to improve the patient experience by prioritizing our ambulatory optimization efforts. This commitment has provided us with exciting new partnerships and valuable resources needed to problem solve and develop best practices that ultimately improve how we do our work and most importantly, the patient experience. The support has been overwhelming at times especially when you see how much we have accomplished in such a short period of time. These efforts have strengthened our teams and reinforced our commitment to our patients and that is something to be proud of.”
Katie Fellows, Interim Administrator, Patient Friendly Access: “If this were easy, we would have done it years ago. I am pleased with the progress we are making as a team. We are working together to discuss the challenges and then using our problem solving techniques to find the best solutions and then making changes as needed. I appreciate to collaboration from the physicians, clinic managers and team members, as well as the Northfork PFA team.”
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