No Show Patrol Aims to Decrease No Show Rate and Improve Performance in Public Health
- Details
- Last Updated on Monday, 09 March 2015 22:34
Robin Wallin
PHN III RN
Madison County Health Department
493 Medical Park Drive
Marshall, NC 28753
Phone: 828-649-3531
E-Mail:
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Project Summary
Background Information on the Area for Improvement
Need for the QI Initiative
How was the need for the QI Initiative determined?See the above answer. Before QI 101 Wave 7 the team lead picked the staff's brains to ask for suggestion for a QI project. Three ideas were given to the team lead. One was budgeting in environmental health to cever fees in the initial permit fee, one was involving clinic flow, and the third was to try and address no show rates (general problem for all clinics). We chose to traget the no show rate due to the clinic being reconstructed during the action period. In order to scale the project down we chose to focus on our biggest program outside of immunizations.
Project Aim:
Project Dates
Initiative Begin Date: Nov 7, 2014Initiative End Date: April 1, 2014
Accreditation Status
Are you accredited by the NC Accreditation Program? YesAre you PHAB accredited? No
If no, do you plan on applying for PHAB accreditation? No
QI Tools/Methods Used
- Value Stream Map
- PDSA Worksheet,
- 8 Waste Worksheet
- Fishbone Diagram
- Surveys
- Standard Work
Root Cause
- No way to communicate with patients about appointments (cannot reach reminder call)
- Patients do not have transportation
- Inclement weather
Implementation of the QI Initiative
Our initiative was to address the no show appointments in our FP clinic. The QI team initially took this project on. During our Kaizen event several things came up that we did not even think about prior to this. Our billing/admin person was able to pull a list of chronic missed appointments and make an alert flag in our EMR to identify chronic no show patients. The front desk staff were brought in to talk about changes with scripting for reminder calls and followup calls for those who miss appointments. Our hopes in this was to eliminate barriers to patients coming to their appointments and identify trends. Our dental center manageer, environmental health specialist and a front desk person completed a Gemba walk and from this created a training manual for admin staff to be able to register a patient. Standard work became a huge focus for us during this initiative. The team lead created a survey for both staff and customers related to reasons for patients missing appointments. During lunch on a day of the Kaizen event nurses were brought in (including the FP program coordinator) and their input was obtained. Also our FNPs were consulted for feedback. We all decided to doublebook on 2 days a week in the mornings to accomodate for missed appointments. Our billing admin person edited the schedule template to allow this.This project involved 6 team members, our Health Director, DON, and admin officer. All staff were also informed of this initiative via a staff lunch. 3 nurses and 2 FNPs were involved with input about changes, as well as an additional 2 admin staff. FP clients were also surveyed via paper and phone. The BOH was presented information about this project as well.
Measurable QI Outcomes
Reduce the rate of no show appointments in the family planning clinc from 32% to 25%- currently at 25% Increase Patient Experience (Client Survey Feedback & Analysis) 1 per patient- acheived Increase/Recoup potential lost revenue (lost income due to no shows) ↑ 4 hrs./day Increase Staff Survey Frequency to once a month- currently we have only completed one survey Increase staff and client satisfaction by 25%-no current data
Intangible Benefits
- Improved communication between clinic and support staff
- Decreased appointment wait time for patients from 6 weeks to 2 weeks
- Improved teamwork and sense of belonging among staff
- Standard Work-training manuals, resource manuals
- No show alert notification in EHR
- Customer input for reaccreditation purposes
Areas for Improvement and Change Ideas Implemented
Improvement 1
Created a training manual for admin staff to be able to register a patient-Gemba walk was completed in order to map the process. Then a training manual was made with screenshots. An admin person who had never registered a patient before then used the manual to create a "test" patient. She provided her feedback and then the manual was edited.
Improvement 2
Clients were surveyed to identify reasons that they could not keep their appoinments. From this a resource manual in house was replicated so that admin staff could refer patients to resources they made need to help them get to their appointments.
Improvement 3
A no show alert notifcation was built in the system. This allows the person scheduling patients to double book with a chronic no show patient, in hopes to be able to fill the spots in the schedule. One problem identified with this process is that once a person is put in the schedule you cannot see the alert notfication to put another person on the schedule beside that client. You have to be in the persons chart to see the notification.
Improvement 4
Introduce the concept of QI into the culture and fostering an atmosphere that embraces change and freedom to 'test' ideas.
Lessons Learned
- Meeting times were very hard to come by. We took this project on during a very busy time in our organization. We were in the middle of reaccreditation and remodeling our clinic to expand services. This pulled staff in many directions. We would advise not to embark on this QI journey in the middle of other projects. Make sure that the staff on your QI team/project are relieved of their other duties during your Kaizen event. Team time is essential during that event. Also make sure that your team has people on it that are interested in QI and optimistic.
Other Information
- Standardization of Work Scripts for “common language” for reminder calls
- Registration manual with images for streamlined process
- Call Log & Waiting List developed with clear directions
- Utilize resource guide for social/physical needs of clients
- Registration manual was developed and all administrative staff will be trained to address staff concerns
- Inner Office Notification of “No Show” patients among registration and clinic staff
- Log Sheets available to record and analyze potential trends. I.e.. Weather delays, holidays esource guide for social/physical needs of clients
