Monday, February 18, 2008

The Biggest Bang for the Buck

What gives the best “bump” to efficiency in a clinic? If I could pick only one tool to decrease health care wait times what would it be?

Offices world wide have a broad spectrum of automation (computerization) and business practices. My old family doctor had his wife run the front desk, the waiting room had five chairs and there was one exam room. I rarely waited once I arrived at the office. On the other hand, I’ve seen emergency rooms with open beds, lots of staff, enough computerization to launch the space shuttle and still experienced 3-5 hour emergency waits.

I can think of many tools that should, in theory, improve the efficiency of a clinic and patient flow, thereby decreasing helath care wait times. There are certain tools that make processes work faster, such as computerized billing, email confirmation, digital lab results and the like. I consider tools like these “velocity tools”. They improve efficiency by leaning down the time of a process.

There are tools that make mistakes or errors on the part of the clinic less likely such as automatic recall schedules and fool-proof treatment tracking. In turn, less mistakes results in less repeated work or more time for clients. There are tools that allow better control of scheduling and patient flow such as computerized booking. These tools decrease the amount of variation in the system by allowing for control of booking and the creation of “pull” which improves efficiency.

Having been analyzing our own data for 7 years I believe that the tools that make mistakes less likely have the biggest benefit. In an already busy practice, velocity tools and variation tools can change individual processes greatly, but the overall effect is only 5-10% each. On the other hand, decreasing errors seems to change the burden 10-20% across the board.

In our case, it means digital treatment plans and recall schedules with strict algorithms to prevent errors. The system makes it impossible to forget about follow-up work to be conducted. Imagine a patient that comes in for a problem then neglects to follow-up. There is time spent in the office tracking down why the person hasn’t followed up and then repeating the work if too much time has elapsed. Not only do appointments and clinic work need to be repeated but so does the administrative burden. In healthcare, this lack of follow-up includes a significant number of people.

Looking back at the data, that single step of fool-proof treatment tracking changed our efficiency by 10-20%. I don’t think I can find another single tool with as large of an effect over the entire practice. So, the one tool I’d pick before all others is a computer system that tracks treatment and follow-up.

3 comments:

Montana Maven said...

Thanks for commenting on my website. You work from your end on the efficiency side in doctors' offices. And I'll keep working on efficiency from my end i.e. the fight for the simple single payer national health care.

I'm worried about the loss of primary care doctors because they have to spend most of their time and money doing paperwork. This is a crisis.
We must have a system like Canada, France, Germany, Japan, Australia or New Zealand. We don't even have to invent the wheel. They've done all the work.

cul said...

I too thank you for your comment left on my site and also for the effort your blog represents in terms of improving the nature of your profession...its above the ususal call of duty and is a fascinating read to boot. Kudos.

Having read several of your posts I get the sense that the need for efficiency (without scarifice of efficacy) is due to a ratio of too few practioners for the volume of clients. Is that the case? Is there simply a shortage of practioners and if so, why is that?

Ian Furst said...

Thanks cul --- here's a link to some good info on the cause of Ontario's doctor shortage.

http://www.cihi.ca/cihiweb/dispPage.jsp?cw_page=media_05jun2002_e