Case Studies

Why?

• Better service level to Patient
• Relieve administrative stress & burden on GPs and Clinical Staff
• Improve practice efficiency & operation
• Use proven business strategies & processes

What?

TQM -Total Quality Management, aspires to total customer satisfaction and focuses on the requirements of the customer – TQM focuses on “prevention” rather than “cure”.

Lean aims to get one process to do only what the next process needs when it needs it; lean value streams extends this concept to link all processes from customer back to initial process.

Value Added Manufacturing (in industry) looks at the manufacturing process in its entirety and breaks down every detailed action into a value add (VA) or non-value add (NVA) activity. Aim is to eliminate all NVAs.

5S – a philosophy that focuses on effective workplace organisation. It simplifies and enhances your work environment whilst improving quality and efficiency.

Kaizen Event – any action whose output is an improvement to existing process. Promotes a “hands- on, get stuck in” approach.

Alpha Healthcare has uniquely adopted a compilation of these techniques applicable to healthcare and has developed a system for the introduction of Value Added Care, VAC©, to GP Practices & Residential Care Centres.

“PATIENTS ARE NOT CARS” – A Case Study

How Industrialised Techniques helped

Background: GPs had invested in a substantive re-modernisation of their practice facility which involved adding new GP consulting rooms and upgrading all existing facilities. The practice wished to upgrade their practice systems to improve patient service and operational efficiency of the practice.

Work: Alpha Healthcare were requested to support the practice with this change program and the company applied its unique VAC© systems methodology to complete a diagnostic on the practice, recommend systems changes and introduce these to the practice.

Outcome: Alpha worked with the practice GPs & staff and introduced:

• Patient focused service measures leading to reduced wait times
• New workflow practices
• More efficient operational procedures
• Re-layout of internal back office
• Pro-active financial management systems
• Enhanced use of practice management software system
• New medical services at practice e.g. Minor Surgery
• Successful implementation & use of own prescribing formulary
• Clearly defined staff roles and responsibilities

Leading to:

• More GP free time to focus on patient care
• Higher levels of patient satisfaction e.g. reduced waiting times
• Increased practice revenue
• Happier work environment and staff morale
• More efficient operating practice

Comments from GPs on Alpha’s services:
“On a personal level, it has taken the administration load off me and apart from doing the actual work it has also taken the worry away” – Cork GP
“If only I had this service 20 years ago” – Kerry GP

Improving Patient Access at GP Practices

Patient Access
Case study: Medical Group – North East England

Medical Group has approximately 14,000 patients and is situated in North East England in a predominately industrial area.

Main Reasons for Change:

• Patients unable to access their preferred GP and restriction son book ahead options,
• Existing system was complex,
• Lack of appointments to see patients on the same day,
• Clinicians unhappy with system,
• Average number of patient contacts with surgery per year was much higher than regional benchmark thereby creating an increased demand on clinical capacity.

Aims & objectives of new service

• Provide patients with improved access to their preferred GP,
• Simplify system for patients, GPs and staff & be consistent in its use,
• Establish a system where all GPs work more closely to share and balance patient appointment demand,
• Aim to reduce unnecessary telephone calls,
• Address all patients calls for appointments first time (eliminate/reduce call-backs and unnecessary calls for the GPs/nurses),
• Reduce patient seeing two GPs when one visit will do,
• System to be responsive to patient needs, efficient and allow some flexibility for GP consulting styles,
• Reduce patient demand levels (inefficient or duplicate demand) whilst maintaining exiting GP capacity; aim is not to force extra work on GPs – reduce average number of patient contacts with surgery to regional benchmark levels.

Access System Analysis:

• Detailed analysis of exiting daily and weekly patient demand – analysed daily, weekly and monthly appointment levels and demands for same day appointments,
• Reviewed clinical capacity,
• Completed patient survey and detailed feedback analysis (as part of the Patient Participation Group initiative),
• Completed detailed supply v demand analysis.

System Changes:

• All system changes were based on the introduction of APC’s defined capacity /demand management system which was then “tailored” to meet the specific requirements of the practice,
• Introduced standardised Clinic start times,
• Extended patient book forward period to 6 weeks,
• The concepts of “emergency and Duty” doctor were eliminated and the complex clinical appointment system abolished,
• A standard approach to clinics where each GP does a mix of routine appointments, same day (or urgent) appointments and telephone consultations was introduced,
• A “Doctor on call” position was defined which had a clinic similar to above but with some of the “standard” clinic appointments changed to “urgent” appointments with a much more balanced workload on this doctor,
• The availability of appointments (capacity) was managed to ensure a good balance between same day and routine appointments.

A daily demand management system was introduced to make all staff, including clinical, aware of the excessive appointment demand. Clinical staff committed to the new system that they would react and support accordingly depending on the warning status;

Key Outcomes of new service:
The access system at the practice was independently evaluated and compared with other practices, before and after these changes:

• Pre-changes – data showed that the practice had an average consultation rate equivalent to 8.17 patient contacts/year,
• Within 6 months – data showed the practice had an average consultation rate equivalent to 6.41 patient contacts/year,
• This is a 21.5 % improvement in 6 months,
• It is estimated that it will take a full year for all the real benefits of the changes we have made to the access system to materialise as it take this amount of time for all the patients at the practice to become familiar with and accustomed to a new system.

Notable improvements are:

• Patients are now consistently able to book an appointment on the day if they need a same day appointment,
• Patients have much greater access to their preferred GP,
• The system is significantly simplified and there is a lesser chance (not eliminated yet) that patients are double booking,
• The reception staff handle all patient queries as they call – they have practically eliminated telling patients to call back (which was generating a lot more work),
• The overall workload is now more balanced amongst clinicians,
• The “triaging” of patient requests by the reception staff re a routine v an urgent appointment appears to be working well.

This is really just the beginning of the process – the positive improvements have taken pressure off the clinicians, staff and the system.

Further identified improvements are:

• The system still has “stressor” points when they is very high demand for appointments and in some instances too many extras are added for clinicians,
• The availability of appointments is still not flexible enough to properly respond to demand – i.e. having the right number of appointments – not too many and not too little and having a “response mechanism” in place when additional “peaks” are encountered,
• Telephone calls workload seems to vary significantly – which makes it difficult to staff appropriately.