Sometimes habits that were originally intended to facilitate work actually end up slowing down work processes over time. Five teams of staff members and physicians recently met through the Accelerating Care Excellence (ACE) program to change habits and improve work flow across City of Hope.

Viviana Diaz, left, and Vivian Caldera steer their cardboard cars as part of a human resources ACE skit. (Photo by p.cunningham)

The teams tackled last-minute additions to infusion treatment schedules, the updating and reconciliation of patient medication lists, reduction of paper waste and human resources management.

Teams reported their successes Sept. 30.

Add-on infusion scheduling

Patients often need to make same-day infusion clinic appointments in the Geri & Richard Brawerman Ambulatory Care Center, but it can be difficult to rearrange schedules to accommodate last-minute changes. Patients may have to wait while staff members juggle scheduling.

“Our goal was to develop a more efficient process so that patients would never encounter long waiting times in such situations,” said Amin Rabiei, lead patient navigator and team leader of the infusion clinic event.

The team established a standard work flow to help staff efficiently deal with add-on scheduling situations. A revised scheduling system identifies available slots for add-on treatments across all infusion clinic areas.

These and other improvements helped to reduce the wait time for add-on patients. Before the ACE event, it took about 54 minutes or more to schedule an add-on treatment. The team reduced the average wait time to 11 minutes at the end of the event, and team members are confident that most patients will experience decreased wait times.

Patient medication lists

Patients often take numerous prescription medications during cancer treatment, besides drugs for other health conditions. A patient’s electronic medical record contains a list of all the medications a patient is taking, but ensuring that the list is up-to-date can be difficult.

“Patient care and safety is our top priority at City of Hope, and we want to be sure that we identify and prevent any potentially dangerous drug interactions,” said Ian Slade, a senior clinical adoption analyst in the Information Technology Services Department and team leader looking at the medication lists. “Updated information would be captured multiple times during a patient’s visit to City of Hope during their different appointments, but reconciling any inconsistencies could be difficult.”

The team established a standard work flow with one source of updated information to reduce confusion. When patients check in for their clinic appointment, they speak with a nurse about their medications. In addition, patients now receive a printed list of their medications at the end of their clinic appointment, enabling them to more easily identify any changes to their medications at their next appointment.

Reducing paper use

City of Hope has hundreds of clinical trials running at any given moment. Three committees meet twice a month to review and monitor these trials, ensuring the safety of patients who participate in studies.

“Each time the three review committees meet, City of Hope uses up to 66,800 pieces of paper for review packages, notes, meeting minutes and file copies,” said Karin Avila, research administrator for the Department of Surgery and team leader focused on reducing paper usage. “We saw an opportunity to reduce the amount of paper used, become greener and create a more efficient review process.”

By the end of the rapid improvement event week, the team improved work flow to deliver materials to reviewers 33 percent faster and cut paper use by 16,000 sheets for each meeting cycle. They also developed a pilot program for some committee members to use tablet computers and laptops containing electronic files rather than paper files. If successful, all future meetings could potentially be conducted electronically instead of using paper.

Human resources

Although the ACE program is focused on improving patient care areas and related services, other areas of the organization have benefited from the process, as well. The Department of Human Resources focused on a key problem: slowed-down processes.

Two teams looked at work bottlenecks in recruitment and compensation requests. Each team streamlined the process for its respective area and identified improvements to cut down on delays.

The next ACE events are scheduled for Oct. 31 through Nov. 4. 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.