NURS 6421 Week 11 change case example

Change Case for the Clinic Operations Committee: Close the Gap Between Referral Status and Scheduling, With Three Options Weighed and a Decision Requested

Student Name

College of Nursing, Walden University

NURS 6421: Supporting Workflow in Healthcare Systems

Instructor Name

Month Day, Year

Change Case for the Clinic Operations Committee: Close the Gap Between Referral Status and Scheduling, With Three Options Weighed and a Decision Requested

Summary

Problem: in our composite sleep medicine clinic, referral status and appointment booking live in two separate systems, and about one referral in four arrives incomplete. Together these cause repeat calls to patients, duplicate referrals, visits booked before authorization and a wait that is longer than it needs to be. Options: change nothing; fix the process without new technology; or adopt electronic intake with self-scheduling. Recommendation: option 2 now, with a three-month pilot of option 3 for one referral source. Cost: about six hours of staff time a week for three months, and a period of disruption for the scheduler and medical assistants. Decision requested: approve the recommendation at the committee's December 3 meeting so the pilot can start with the January referral cycle.

The Problem in Operational Terms

Every booking requires the scheduler to search for the same patient in two systems and return to the first to close the referral. When the return trip is missed, the referral stays open and a colleague calls the patient again. Referrals that arrive incomplete are returned to the referring office by fax, and the returned pages are sometimes logged as new referrals. Authorization status is updated late, so some visits are booked and later canceled. None of these problems is caused by any one person; each arises where information has to pass from one system or organization to another. That pattern is why the options below are judged by how well they close those crossings rather than by how much technology they add.

Evidence

All evidence comes from this term's work on the clinic. The Week 3 current-state map shows 22 steps, three rework loops and the four slowest steps. The Week 4 task analysis shows 19 actions in a single booking, two of them pure searches and three carrying every failure. The Week 5 gap analysis ranks six gaps by staff burden and shows that two of them are symptoms of the two-system split. The Week 7 future-state map shows how electronic intake would remove eight steps and what work it would move to others. The Week 8 workaround inventory shows that staff already compensate for the split with second windows and memory. No figure in this case comes from outside those artifacts.

Options

Option 1: change nothing. This option deserves a serious hearing. The clinic's patients do get seen; the scheduler and front desk have built reliable informal habits; and every change carries disruption. The cost of doing nothing is the continuing burden in the gap analysis and the repeat calls that annoy patients and staff. It is a reasonable choice if the committee judges that current staff can sustain the workload and that no staffing change is coming. The risk is that the informal habits depend on a few experienced people, and the process would degrade if they left.

Option 2: fix the process without new technology. Four changes: the front desk screens every referral for completeness on arrival using a one-page checklist and calls, rather than faxes, the referring office for missing items; returned pages are attached to the existing referral before anything else is done; the scheduler closes the referral before ending the booking call, using a scripted final step; and the authorization coordinator updates status the same day an answer arrives. Cost: about four hours a week of front desk time for calls, offset partly by fewer duplicates, and one hour a week of training in the first month.

Option 3: electronic intake with self-scheduling, as mapped in Week 7. This removes the most steps and addresses the two-system split directly, but it moves work to referring office clerks, patients and medical assistants, and it depends on assumptions about uptake that have not been tested. Order entry research found that new work for clinicians and unfavorable workflow changes were the most common unintended consequences of new systems (Campbell et al., 2006), and the future-state map predicts the same here.

Recommendation

Adopt option 2 now for all referrals, and pilot option 3 for three months with the single largest referring practice, which already uses the health system's portal. Option 2 addresses the most burdensome gaps quickly and at low cost, and it creates the clean baseline needed to judge whether option 3 is worth its disruption. The pilot will measure the share of pilot referrals that arrive complete, the share of patients who self-schedule, calls to medical assistants about the link and the number of repeat calls to patients. Managing change in clinical information systems depends as much on people and communication as on technology (Lorenzi & Riley, 2000), so the pilot includes a named contact at the referring practice and a weekly fifteen-minute check-in with the scheduler and medical assistants.

Consequences for the Unit

The cost is expressed in staff time and disruption, because no budget figures were observed in this work and inventing them would undermine the evidence behind the case. For the first three months, the front desk will spend about four more hours a week on completeness calls; the scheduler will spend an hour a week in check-ins; and the medical assistants will field some questions about the pilot link during rooming. The scheduler, whose habits carry the current process, will be asked to change the most, and should be involved in writing the scripted final step. Maps are most useful when they feed an improvement effort rather than standing alone (Antonacci et al., 2018), and this case is where the term's maps are put to that use.

Decision Requested

The committee is asked to approve option 2 and the three-month pilot of option 3 at its December 3 meeting. A decision by that date allows the checklist and script to be in place for the January referral cycle and the pilot to report at the April meeting. A decision after January 15 would push the pilot past the spring, when referral volume is highest and the clinic can least afford disruption.

References

Antonacci, G., Reed, J. E., Lennox, L., & Barlow, J. (2018). The use of process mapping in healthcare quality improvement projects. Health Services Management Research, 31(2), 74-84. https://doi.org/10.1177/0951484818770411

Campbell, E. M., Sittig, D. F., Ash, J. S., Guappone, K. P., & Dykstra, R. H. (2006). Types of unintended consequences related to computerized provider order entry. Journal of the American Medical Informatics Association, 13(5), 547-556. https://doi.org/10.1197/jamia.M2042

Lorenzi, N. M., & Riley, R. T. (2000). Managing change: An overview. Journal of the American Medical Informatics Association, 7(2), 116-124. https://doi.org/10.1136/jamia.2000.0070116