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    Cheryl Becker
    Cheryl Becker, CPHQ

    Aurora Children’s Health eliminates the wait, pleases patients and parents

    Walk into any pediatric practice across the country and what are you likely to see? A waiting room filled with parents and children sitting shoulder to shoulder. Kids might be coughing, sneezing, crying and fighting over toys. Parents might be trying to keep their newborn or well child on the “healthy” side of the room. Everyone might be growing more and more uncomfortable as the clock continues to tick.

    No one likes this scenario. Doctors don’t like it because it means that they are behind schedule, and they can feel rushed to see patients. Clinic staff members don’t like it because they are likely to be on the receiving end of complaints. Parents don’t like it because their children are being exposed to myriad germs. And, of course, pediatric patients don’t like it because they are sick and they just want to go home and crawl into their own beds.

    When Aurora Children’s Health + UW Health at Aurora BayCare Medical Center in Green Bay, Wis., had the opportunity to build a new pediatric clinic, we wanted to eliminate the waiting room altogether. But that was only part of our vision. We also wanted to create an atmosphere where caregivers and physicians would not spend an inordinate amount of time walking the halls trying to find one another. Staff would not waste time finding one another but, instead, could look to the tracking board to know where everyone was and how to contact them. And we wanted to create an aesthetically pleasing, welcoming environment where young patients and their parents would feel at ease.  

    Certainly, such an environment would help to improve the overall patient experience — an increasingly important element of success as reimbursement under emerging value-based models hinges, in part, upon patient satisfaction. 

    Implementation

    To turn this vision into reality, however, we needed to move beyond the traditional “we-will-get-to-you-as-fast-as-we-can” waiting room model. As such, we implemented a variety of innovations, including: 

    Wheel scheduling. Instead of continuously seeing patients and then working on documentation and other administrative duties at the end of the day, our providers now schedule patient visits in increments while still reserving time for documentation and other tasks at the end of each hour. With this model in place, specific periods are blocked out for specific purposes. For example, the most complex patients are always seen at the top of the hour in case more time is needed for the visit, followed by acute, follow-up or same-day appointments. The end of each hour is reserved for dictation, documentation, follow-up phone calls and other administrative tasks or to accommodate visits that run over the scheduled time. 

    This scheduling model standardizes workflow yet allows for needed flexibility. Physicians can be more productive without feeling the stress that is commonly associated with conventional scheduling. 

    Onstage, offstage design. Under this model, spaces within the clinic are designated as public or private. As a result, patients are not exposed to “behind-the-scenes” activities and conversations that normally occur in nursing stations. Dual-access patient rooms with sliding doors let patients enter from a public hallway and staff from a private back area. Sound masking, using a combination of white noise and pink noise, provides added privacy as conversations outside the exam room cannot be heard from within.

    Engaging (and practical) aesthetics. We have also taken great care to ensure that our clinics use color and various motifs to engage families on an emotional level. Wall murals with realistic animal images and themed light covers in exam rooms and corridors as well as sparkle lights in ceiling tiles add to the experience. Colored walls and floors coordinate wayfinding to exam rooms in the Safari, Ocean or Jungle sections with themed signage. Rounded edges on exam tables, sturdy step stools, benches instead of chairs, continuous surface countertops and sinks, stools without wheels and magnetically locked drawers and cabinets help to maintain safety in exam rooms. Every room has computers, infant and adult scales, stadiometers, eye charts and playscapes to enhance efficiency.    

    Enabling technology. To move staff and patients effectively throughout the facility, we implemented an automated communication system that serves as “air traffic control.” With this real-time locating solution (RTLS) in place, every step of the patient experience is shared in real time on monitors throughout the facility. By assigning locator badges to patients, providers and staff, the system tracks which rooms are available, where patients and staff are located, who has seen the patient and who needs to see the patient next. 

    The new patient experience 

    With these innovations in place, patients are no longer greeted by a noisy room full of anxious parents and sick kids when they walk into our clinic. 

    Instead, each patient receives an RTLS badge from a patient service representative (PSR), who directs the patient to an exam room, with no time spent waiting. Because the RTLS automatically monitors room availability, the PSR simply glances at a computer screen to see which rooms are available. The patient and parents follow visual cues to the exam room along the Safari, Ocean or Jungle hallway and enter the exam room through the “onstage” entrance. 

    A large screen display, monitored by a medical assistant (MA) or licensed practical nurse (LPN), shows each room, its status, who is in the room and how long the patient has been waiting. The MA or LPN (who also wear locating badges) then enters the exam room through the offstage door to take the patient’s vitals. After the MA or LPN leaves, the physician can easily see on the monitor that it’s his or her turn to be with the patient. If the physician needs assistance or an ancillary service such as a vaccine, the provider presses the button on the RTLS badge that sends a pop-up message to the MA’s and LPN’s computers. 

    At the end of the visit, the patient leaves through the onstage hallway and places the RTLS badge in a themed drop-box at the end of the hall. Once the badge hits the drop-box, the patient visit is complete and the RTLS system cues the MA or LPN to clean the room. Once the room has been cleaned, the system automatically marks the room available for another patient.

    Beyond pleasantries

    Reimagining the typical clinical environment and implementing these innovations has added more to our medical practice than an environment that is more pleasant for patients and staff. Additional benefits include: 

    More access for patients. Using wheel scheduling, our providers have a predictable daily workflow. However, even though the pace of work is more manageable with this scheduling model, physicians see more patients during their office hours. This has been accomplished while maintaining top-performing clinical quality measures and top-quartile service quality performance based on CG-CAHPS surveys.  

    More opportunities for collaboration. The onstage/offstage concept creates a much more collaborative environment. Offstage, general and specialty pediatricians along with their staff sit in a common work area where they can discuss patient care planning and coordination. We find that physicians will stay in this area during patient care hours and no longer “disappear” into their offices. They are more available for clinical questions from our triage nurses, who love the increased accessibility to the physicians. Nurses don’t waste time following the doctor around or waiting for him or her to be available. They can locate any physician on the floor plan and determine if the provider is available to answer questions.

    Increased productivity. In this collaborative environment and with cues from the RTLS, everyone knows what needs to happen next. Patients are roomed quicker, and patient visits take less time.

    This all leads to increased productivity for the providers. On the first day we opened the clinic, one physician was amazed that he had his most productive day ever and still left the clinic on time with all administrative work complete. 

    Improved patient satisfaction. Perhaps most important, our patients report that not having a waiting room and being seen quickly and efficiently by their provider led to a better overall experience. In fact, patient comments on the CG-CAHPS survey rave about the new self-rooming process.

    Moving beyond the conventional waiting room model has enabled our clinic to offer patients a unique care experience, eliminating many of the frustrations that are commonly associated with the typical doctor’s visit. Physicians and staff members also enjoy this innovative model. Ultimately, these changes to how we deliver pediatric care are positioning our medical group to succeed under emerging value-based reimbursement models, which demand superior clinical quality, service quality and cost efficiency. 

    Cheryl Becker

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