Nothing may be constant but change — but in health care, change can have a big, unintended impact on a patient’s experience. At City of Hope, staff members are trying to harness that change for the better through the Accelerating Care Excellence (ACE) program.
A rapid improvement team recently met to try to reduce outpatient appointment cancellations and rescheduling, while a process preparation team gathered to begin tackling the challenge of managing supplies for a new surgical center set to open in the Michael Amini Transfusion Medicine Center in 2011. The teams reported their early efforts to the City of Hope community on May 28.
 Robert Lee stands ready as Sharon Steingass introduces her team’s skit. (Photo by p.cunningham) |
Appointment scheduling changes
City of Hope’s registration staff schedules about 2,600 outpatient appointments each day. About 300 appointments get cancelled or rescheduled.
“We need to reduce the number of cancelled and rescheduled appointments in order to enhance our patients’ experiences,” said Tricia Cascione, vice president in the strategic program office and the team’s executive sponsor.
Many appointment changes arise when patients ask to cancel or reschedule, or when a patient’s condition changes. However, some of the cancellations stem from internal issues, such as procedures taking longer than expected, delaying a room’s availability, Cascione explained.
The team found that the causes of appointment cancellations or changes were not always clear.
“We found our system isn’t as flexible as we’d like,” said team leader Robert Lee, a registration representative in radiology. “Oftentimes what appeared to be a rescheduled appointment was really just a move to a different procedure room or floor.”
The team is developing several strategies for countering avoidable appointment changes. They also plan to provide staff training and revise scheduling software. In addition, the team aims to find ways to let patients stay in one room for procedures that currently require visiting several locations in the medical center.
Supplies for a new surgical center
The ambulatory surgery center, slated to open in July 2011, will focus on outpatient surgical procedures. The center shares building space with the blood donor center, including limited shipping, receiving and storage room. Louis Magdits V, surgical business administrator in the Department of Surgery, and a process preparation team set out to establish a successful plan for managing supplies well before the surgical center opens.
Magdits and his team carefully studied the procedures staff currently use to manage the flow of surgical supplies in City of Hope Helford Clinical Research Hospital. Their efforts pointed not only to methods they can use for the new surgical center but also to ways staff can improve the system now in place in Helford Hospital.
“Our goal is to get a head start on the ambulatory surgery center, but it’s really gratifying to know we’ll implement some of our findings sooner, in Helford Hospital,” said Magdits.
The next two ACE events, scheduled for the week of June 21, will be process preparation events. One event will focus on planning for a new call center; the other will focus on integrating some of the new procedures Magdits’ team developed during the May event in the current operating room material management processes.
For more information, employees may visit www.coh.org/ACE. Questions about ACE also may be addressed to Tricia Kassab, R.N., B.S.N., M.S., vice president of quality and patient safety, at tkassab@coh.org.
Improvements continue The ACE program has conducted 14 rapid improvement events since November 2009. Teams focus exclusively on one area for a week to implement improvements immediately, but they also ensure that improvements continue.
“These teams are incredibly focused and committed to their projects,” said Tricia Kassab, R.N., B.S.N., M.S., vice president of quality and patient safety. “Their efforts are paying off and making a tremendous difference in our ability to provide the best patient experience possible.”
Achievements continue: - Patients scheduled to undergo surgery with general anesthesia must be evaluated in the Pre-anesthesia Testing Center prior to surgery to avoid treatment delays. The number of patients visiting the center is up from nine per day to more than 14 per day, a nearly 50 percent improvement, and the number of delays is down from 15 percent to 2 percent.
- Patients now complete their appointments in the pre-anesthesia center within one hour, an improvement of more than 40 minutes.
- A team addressing operating room scheduling has increased the percentage of time staff was successful in scheduling a case at first attempt from 63 to 87 percent in the past two months as a result of better process efficiencies.
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