New workflow equals better results, lower costs

What comes to mind when you think about working differently to improve customer service and align costs with falling reimbursements? If you ask team members from EnhanceMed/Mayo Clinic Outreach, Rochester, Minn., their responses would include:

• Measurable process improvements
• Significant cost reductions
• Improved employee job satisfaction
• Expanded service offerings
• Opportunities to learn new skills

In 2012, we merged the specialty clinical outreach and EnhanceMed, an after-hours staffing group for urgent care, emergency department and hospitalist services, into a single physical location owned by the Mayo Clinic. The goals of the merger were to decrease campus space; save on equipment and supplies; and capitalize on similar work activities, such as contract management, billing, medical provider orientation, credentialing and privileging.

The process took a year and was painful at times because staff had little experience in team-related activities, had limited knowledge of continuous improvement processes and had worked in silos for many years, which created barriers to effective team dynamics. We formed project teams to identify gaps and goals for improvement and shared successes related to work improvements. The result is a 40% overall improvement in workload capacity and a better-aligned, cross-trained team. Figure 1 summarizes the process improvement gains.

Despite a reduction of two full-time-equivalent staff members, the combined units are able to deliver higher volumes of service. The number of outreach specialty services increased from 129 per month to 158 per month, and the number of monthly services for EnhanceMed rose from 27 to 33. Figure 2 shows the gains achieved from working different dynamics.

Initially, we took advantage of staff transitions and organizational change. For example, outreach telemedicine services were transferred to Connected Care, a program created to manage electronic patient encounters across all Mayo Clinic sites in Florida, Arizona and Minnesota. This transition occurred over nine months and involved transitioning providers to new equipment and a new video connection portal.

To enhance efficiencies and manage workflows among reduced staff, we used Lean principles and value stream mapping. Lean tools and techniques include standardized work and workplace organization such as 5S (Sort, Set in Order, Shine, Standardize and Sustain) to maximize quality and efficiency by eliminating waste. Value stream mapping creates a visual flow of a process or activity, and uses observations and data collection to help identify variation and inefficiency.

We converted many daily work processes from paper to electronic resources and streamlined the flow of service components. For example, e-faxing replaced traditional paper faxes, and the exchange of outside medical materials is now managed electronically. Paper binders, which contained patient schedules and medical information, dictation instructions and driving directions for providers, have also been replaced; patient schedules and medical information are exchanged electronically, and the rest of the information is available electronically and in a single binder at each site.

Overall, the combined team has achieved significant benefits as a result of working differently. Each team member engages in shared decision-making and has learned that individual success is dependent on others. Consistent processes have allowed team members to support and encourage each other and assume additional responsibilities, such as metrics management and credentialing support. Team members are also aware that their feedback and opinions matter, and they take time during team meetings to discuss issues and ask questions.

“Don’t fear the unknown; seek to understand and define it” has become the philosophy of the combined team. Before merging, these two teams experienced a few changes over the years. Now team members appreciate and understand that the only constant is change. 

We can all benefit from managing change by working differently and finding opportunities to deliver service efficiently and at a lower cost.