By Roger Gruneisen, MS, LSSBB, Manager of Consulting Services, Midmark Corporation
It’s important to improve processes and patient flow before knocking down walls.
Waiting rooms provide zero value.
They often cause stress for both patients and providers who are trying to stay on schedule in their busy lives and, when backed-up, can send a signal that physicians are running behind and patients should expect a long wait. Further, there is the potential for a patient’s condition to be made even worse by germs spreading from others.
Some medical group practices, however, are trying to improve patient flow and satisfaction by eliminating the waiting room entirely. These organizations have or are moving to what’s known as self-rooming, where arriving patients are immediately assigned to an exam room, thereby bypassing the traditional waiting room.
The results from such change initiatives are reaping huge benefits. Many of our outpatient care clients are seeing significant gains in patient satisfaction scores, increased capacity, and improved provider and staff satisfaction, while reducing the unproductive space in a typical practice.
But realizing a “no waiting room” vision requires much more than knocking down walls and rearranging the furniture. In fact, there are many interconnected moving pieces that can affect how long patients wait, whether in the waiting room or the exam room.
As such, evaluating and possibly changing processes and procedures may be needed before tossing out the waiting room. To improve efficiency and quality, many organizational leaders are embracing process improvement techniques such as Lean, a long-term approach that seeks to achieve small, incremental changes in processes.
Data is the backbone of any evidence-based design—and many who are implementing self-rooming are doing so with data derived from a real-time locating system (RTLS). These systems assist the self-rooming process in the moment by monitoring patient, clinician and room status in real time, and providing a visual indication of that status to the entire practice staff. RTLS also automatically collects data about processes—wait times, space utilization, staff productivity and more.
Before eliminating the waiting room, medical practices should know exactly where they stand. Leaders should determine how well they are managing and scheduling their patients compared to the capacity of their providers and facilities. How long are patients waiting? How long do visits take? How much time do providers spend with patients? Are exam rooms being fully utilized?
The typical method of documenting processes manually with a clipboard and stopwatch captures limited data and is labor intensive. With RTLS, patients and clinicians simply wear locating badges that automatically collect the same information, providing the data required to identify where improvements are needed.
After analyzing the data and determining where there are performance issues, leaders can optimize patient flow by implementing changes to the capacity constraint. Because most capacity constraints involve provider capacity, organizations should evaluate how much time their providers are devoting to patient care and decrease the time they are spending on other non-value-added tasks.
For example, some “hunting and gathering” tasks waste a minute here and there, but over a day, that time contributes to reduced patient throughput. Freeing providers from such tasks is often referred to as having them operate at “top of license.”
Some examples of these time busters that throw off schedules include:
Provider organizations also should assess the scheduling process effectiveness. Again, precise and accurate RTLS data can help. Some appointments, such as new patients, require a longer visit than other routine ones. Some providers work at a different pace than others. If practices plan too little time for patients, they will get backed up. If they allocate too much time, then providers can have idle time and less patient throughput. With accurate data on how long these processes actually take, provider organizations can effectively calibrate scheduling to improve throughput and have a successful self-rooming process.
Once provider organizations have determined what’s behind their time crunch, they can implement new technology, make process improvements or reconfigure the actual physical space of the facility. But before making any kind of change, determining how it will affect their staff, physicians, patients and culture is key.
They should prepare all affected staff and do a team-based change first. Involve staff members in determining changes to test, then assess the results after a period of time. If the change doesn’t result in the desired improvement, practices should evaluate how they can tweak it to make it better. If it was successful, they should determine how to maintain it.
Once a practice is ready to eliminate the waiting room, RTLS technology can then be used to support the self-rooming process. By adding patient flow software to the RTLS, front desk staff can know at the glance of a screen which rooms are ready and available for patients so that a patient is dynamically assigned the next available room.
By giving patients a locator badge, their arrival in the exam room is automatically communicated to nurses and providers. When staff also wear the badges, the RTLS-enabled patient flow system automatically communicates to the whole care team who has seen the patient, and who needs to see them next.
If a patient has waited longer than normal, the system will even send an alert, so the patient’s expectations and experience can be proactively managed.
The real-time intelligence provided by the patient flow system can be used to streamline throughput in the moment—and the data collected can be used to amend future scheduling and time-management processes.
While it takes considerable effort to implement the change management programs as well as the supporting technology that can help practices improve patient flow and eliminate waiting rooms, the effort is worth it—as self-rooming typically results in significantly improved patient and provider satisfaction, as well as increased space utilization. Such a change can be a huge differentiator in the marketplace.