HLTH 6882 Week 6 Healthcare Change Proposal Paper Example

Change Proposal: A Three-Week Booking Window and Short-Notice List for Prairie Bend's Visiting Specialist Clinic

Student Name

Walden University

HLTH 6882: Improving Healthcare Performance Through Social Entrepreneurship

Instructor Name

Month Day, Year

Change Proposal: A Three-Week Booking Window and Short-Notice List for Prairie Bend's Visiting Specialist Clinic

The Change in One Paragraph

Prairie Bend Community Hospital will stop booking specialist referrals into the next open slot on arrival. Instead, non-urgent referrals will go onto a holding list, and each session day's slots will open for booking three weeks before the session. Patients on the holding list will be asked whether they can come at short notice, and those who can will form a short-notice list. When a booked patient cancels late, the slot will be offered to patients on that list. A one-week text reminder with a reply-to-cancel option will be added. These tasks will belong to an outreach coordinator function of about ten hours a week, carved from hours the scheduler already works, with registration coverage on clinic days shifted to a float clerk. Urgent referrals will still be booked immediately. Figures throughout describe a composite hospital and are illustrative.

Mechanism

Each component of the change acts on a specific link in the cause chain traced in Week 4.

The three-week window acts on the root cause directly. Lost slots were concentrated in visits booked 43 or more days ahead, which were lost at a rate of 37%, compared with 10% for visits booked within three weeks. The window removes most long-lead bookings by design, moving visits into the lead time band where the clinic already keeps 90% of slots. The mechanism rests on the clinic's own data and on a systematic review that ranked lead time among the strongest recurring predictors of no-shows (Dantas et al., 2018).

The short-notice list acts on late cancellations, which were 30% of lost long-lead slots. A slot freed late is currently lost; with the list, it can be refilled. Cedar Ford, the peer hospital, refills about half of late cancellations this way.

The one-week text reminder acts on forgetting, the most common reason in the scheduler's call-back notes. A Cochrane review pooled trials showing that texted reminders raise attendance relative to sending none (Gurol-Urganci et al., 2013). The reply-to-cancel option turns some no-shows into cancellations early enough for the short-notice list to fill.

The coordinator function acts on the fourth link in the chain: bookings made whenever the scheduler had a free moment between registration tasks. Giving the booking work protected hours makes the window and the list possible to run.

Roles: What Staff Start and Stop Doing

The scheduler will become the outreach coordinator for about ten hours a week, spread across two afternoons and the mornings before each session day. In those hours, the coordinator manages the holding list, opens slots three weeks ahead, books patients, keeps the short-notice list and calls it after late cancellations.

The scheduler will stop covering outpatient registration on the four session days a month, when registration is busiest; a float clerk from the business office will cover those shifts. The scheduler will also stop the current practice of calling no-shows after each session to rebook them, because the holding list and the window replace it. The reminder letter mailed at booking will be discontinued, since the text reminder replaces it. These stopped tasks account for most of the coordinator hours; the remainder comes from the float clerk's coverage.

Reaching Past the Hospital's Own Resources

Patients on the short-notice list must be able to reach the clinic at a day or two's notice, and some may need a ride. Prairie Bend does not run transport and should not start. J. Gregory Dees described social entrepreneurship as pursuing opportunities without being limited by resources currently held (Dees, 2007). Applied here, the hospital can ask the two counties' aging offices, which run volunteer driver programs for older residents, to accept short-notice ride requests for patients called from the list. This does not respond to transport as a general cause, which the root cause analysis rejected. It responds to a narrow need the new process creates.

Constraints

The change was checked against the clinic's main constraints.

Table 1

Constraints Check for the Booking Change (Illustrative)

Patients Who Might Be Harmed

Two groups could be worse off. Patients whose referrals are not flagged urgent, but should have been, would now wait on the holding list instead of holding a booked date. The proposal handles this by asking the coordinator to call any referring provider whose referral has waited more than six weeks unbooked. Patients without a mobile phone would not receive text reminders; for them, the coordinator will make a reminder call. Both safeguards will be monitored in the pilot. A third group, the specialist groups themselves, could be affected if patient lists arrive later than they are used to. The proposal answers this by sending each group its list one week ahead, as the contract asks, and by sharing the short-notice list's results with the groups after each session so they can see whether their days are fuller.

What the Proposal Excludes

The proposal does not add session days, change the specialist contracts, start a hospital transport service, introduce telehealth visits or change the referral criteria. Each may have merit, but none addresses the diagnosed cause, and including them would make it impossible to tell which part of a change produced any improvement. Advanced access work warns that clinics often add capacity when the real problem is how existing capacity is booked (Murray & Berwick, 2003); this proposal tests the booking rule first.

References

Dantas, L. F., Fleck, J. L., Cyrino Oliveira, F. L., & Hamacher, S. (2018). No-shows in appointment scheduling: A systematic literature review. Health Policy, 122(4), 412-421. https://doi.org/10.1016/j.healthpol.2018.02.002

Dees, J. G. (2007). Taking social entrepreneurship seriously. Society, 44(3), 24-31. https://doi.org/10.1007/BF02819936

Gurol-Urganci, I., de Jongh, T., Vodopivec-Jamsek, V., Atun, R., & Car, J. (2013). Mobile phone messaging reminders for attendance at healthcare appointments. Cochrane Database of Systematic Reviews, (12), Article CD007458. https://doi.org/10.1002/14651858.CD007458.pub3

Murray, M., & Berwick, D. M. (2003). Advanced access: Reducing waiting and delays in primary care. JAMA, 289(8), 1035-1040. https://doi.org/10.1001/jama.289.8.1035