All Care Health Center Case Study Client Profile: All Care Health Center began in 1997 providing medical services to Council Bluffs and surrounding areas, adding a dental clinic and pharmacy in 2012. Always cognizant of the vulnerable community around them where most are, at most, 200% above federal poverty levels, they provide transportation assistance and other services to ensure service for everyone. They also partner with a homeless shelter, staying onsite to provide medical and dental care for families and individuals. Challenge: In this case, the role of the consultant was to assess the general state of the practice and determine areas that could be improved. She found that communication between departments suffered due to office layout and siloed management, which also had an effect on the patient flow. Struggling to keep up with patient expectations in a fractured model also caused distractions of equally important aspects of the practice, like inventory management. Solution: Pamela Ballou-Nelson, RN, MSPH, PhD, CMPE, consultant, MGMA Consulting, sought to execute on well-established strategies for the issues surrounding the staff and patients at All Care Health Center, yet wanted to benefit from personal accounts from the staff in interviews to implement customized touches. Her years of experience facilitated the entire process with seamless transition from initial engagement to solution-oriented actions, rounded out with buy-in at every level of the organization. Results: Pam worked with the organization to identify the key areas where her extensive knowledge and past successes would make the most impact. This was a combination of implementing the most scalable improvements for the areas most frequently executed on, like payment processing, or had an overarching impact on everyone in the organization, like communication. Workflow and process mapping Visualizing their processes allowed everyone involved in these processes to look at them objectively; when someone is facilitating a process every day, objectivity is a luxury that disappears into repetition. However, the trinity of objectivity, process familiarity and expert guidance is easily one of the best recipes for optimized innovation! Laying it out allowed the staff to see exactly where gaps and breakdowns were. Brainstorming solutions using the How-How Diagram and Five-Whys also gave a voice to those who felt unheard, empowering critical members of the team who were eager to lift the organization as a whole. Communication Fortunately, aside from everyday politics experienced in every workplace, the breakdowns in communication were not based on animosity or poor emotional intelligence. Pamela found two key solutions to barriers and breakdowns: fix process gaps and open the office space (literally). In the How-How Diagram exercise, hand-offs in the process were the most common gaps riddled with miscommunication. Removing ambiguity, identifying responsible stakeholders in every process and holding leadership accountable immediately improved communication related to basic and complex operations. They even went so far as introducing a new staff member, a Coordinator, who was responsible for facilitating communication and inter-departmental handoffs. Another solution to communication barriers is to remove physical barriers – walls, cubicle partitions, doors and any other physical barrier that inhibits conversation. This will be an ongoing process at the organization, but the staff agreed that "Pam really had an effect [there]". Financial opportunities With no specific concerns about revenue or costs, the organization was pleased when the effects of Pamela's guidance spilled into these areas. As they say, waste is a thief; through improving communication, processes and breaking down silos, there was more attention to inventory management, transparency of financial goals, and appropriate amounts of supplies being ordered. With everyone on the same page, duplicative orders were eliminated as were redundancies in overlapping workflows. The efficiency of the staff's effort ensured they were optimizing their time as well as those around them. In addition, more time could be spent on customer follow up, rescheduling and appointment reminders, all having been long neglected. Looking ahead The organization's goal of transforming their environment into what they have been striving for is partially realized, with the balance lying in the days ahead. Long-term effects of the changes that have already displayed short-term returns will fully take shape with commitment to the processes they worked hard to architect. Even more, their optimism has transcended into innovating growth opportunities in new concepts and service lines. Expanding more into community outreach through virtual visits and rehab and medication management programs will open up new business in concert with improving the health of the community, and potential partnerships will allow them to penetrate new markets.