When patients get a diagnosis of cancer, many feel like they are in a race against time to beat the disease. But some potential patients making their initial call to City of Hope for treatment have reported frustration with that quest.

From left, Mickey McCabe, Terry Closson, Leanne Dinh, Stella Montes and Kristina Johnson perform a skit to demonstrate patient scheduling delays. (Photo by p.cunningham)

The patients encountered a long process that delayed their first appointment with a physician — a surprise to staff members participating in one of City of Hope’s first two rapid improvement events this year.

The team was committed to improving the often complicated new-patient process through City of Hope’s Accelerating Care Excellence (ACE) program.

A second rapid improvement event addressed another key part of the patient experience for many: patient flow through the 3B medical oncology clinic in the Geri & Richard Brawerman Ambulatory Care Center.

Both teams reported their achievements in improving care Jan. 8.

Initial phone call

“Our team recognized early on that one of the most important things to a newly diagnosed cancer patient is time, and our processes sometimes did not respect that,” said Heidi Hebson, administrative director of the Office of the Chief Strategy and Administrative Officer and team leader for the initial phone call experience.

To kick off the improvement effort, the team focused on calls to New Patient Services for appointments in the General Oncologic Surgery, Gynecology and Urology departments and the Rita Cooper Finkel and J. William Finkel Women’s Health Center.

They found that some requests took on average 50 hours, up to seven different phone calls and more than 30 hand-offs between employees before staff scheduled the initial surgical appointment, Hebson said. “In these cases, appointments were, on average, an additional 14 days later.”

Shirley Johnson discusses satisfaction and efficiency measures during a rapid improvement event. (Photo by p.cunningham)

“If we set high expectations for ourselves, we know we can achieve them because staff from various departments work as a team,” said Virginia Opipare, executive vice president and chief operating officer.

The team simplified and quickened the process, creating a short list of information patients must provide to schedule an appointment. They also smoothed communication between New Patient Services and physicians’ administrative staff to better coordinate available appointment times. In addition, they began using an instant messaging system to immediately alert triage nurses about new patients — allowing nurses to speak to patients quickly — and minimized financial screening during the first call.

“We were able to reduce the time from initial call to confirming an appointment from 50 hours to about 1 hour — in one call — providing immediate peace of mind to patients,” Hebson said. “We’re going to continue these efforts to see how we can make similar improvements across all of our specialties.”

3B medical oncology clinic

Staff members already improved patient flow in the 2B surgical clinic in City of Hope’s second set of rapid improvement events, but medical oncology patients often have different needs from surgery patients. The team focused on the 3B clinic to understand the differences — yet found similarities between challenges in both clinics.

“Our patients have experienced some issues with their clinic appointments such as long waiting times and the need to check in for each step of their visit,” said Mary Scott, director of clinical practice and education and team leader of the 3B effort.

“Our physicians also expressed some frustration with work flow delays and room scheduling,” Scott said. “Our goal was to improve the experience for everyone.”

Among their achievements:

• They installed flags outside clinic rooms to quickly show the status or availability of the room, making the flow more efficient.
• Vital signs are now taken in exam rooms, reducing patient moves between waiting areas and patient rooms.
• With help from Facilities, a vital signs room was converted into an exam room and another room was converted to a consultation room, creating more space for appointments.
• A new registration desk near the elevators allows patients to conveniently check in; that single check-in automatically registers them for all parts of their medical oncology visit.

Patients’ feedback indicated that they immediately liked the improvements.

“We had one patient tell us that this has been the best change in the past six months, and another expressed her astonishment that her husband was able to see his physician five minutes after they checked in,” said Shirley Johnson, R.N., M.S., M.B.A., chief nursing and patient services officer.

Before the event, patients typically waited for nearly 40 minutes after their scheduled appointment time to see their doctor. The team aimed to reduce that to 19 minutes. After implementing some changes, the team observed wait times ranging between five and 45 minutes.

“We saw that even changes small in scope could make a big impact, and while we are glad to achieve such success, we know that there are always areas we can improve and issues to address,” said Scott. “It’s an ongoing process and we are determined to continue to improve this process.”