February 11, 2013
Prairie North Health Region recently held its first Rapid Process Improvement Workshop (RPIW), a five-day improvement event that brings together 5-8 employees from across the Region to improve a complex, common process that affects patients and the care they receive. The purpose of the workshop is to eliminate waste and to create a more reliable, efficient, patient-driven process.
No news is good news—that's the old, accepted wisdom when it comes to hearing back from the doctor's office about pending test results, right?
The primary health care team at Meadow Lake Primary Health Care Clinic has decided that's not good enough for their patients. The long-term vision coming out of a recent Rapid Process Improvement Workshop (RPIW) is to find a reliable process to communicate all test results—good and bad—to patients within 10 days of the test being completed.
From January 28-February 1, a team of medical office assistants, a nurse practitioner, lab and diagnostic supervisors, a patient, and other clinic and regional staff worked together for five days to study the report-back process, identify ‘kaizen bursts' or opportunities for immediate improvement, and try out various solutions to the problems.
While much work must be done in the coming weeks to realize all of the workshop's potential, team members have already made changes that will improve patient safety.
Some of the immediate improvements include:
- Setting the clear expectation for staff that all test results need to be imported daily into patient electronic charts;
- Ensuring results are initially reviewed and sorted by appropriate, qualified staff as the results are received at the clinic;
- Improving the scanning and importing process through MedAccess to make the workload more visible and easier to manage;
- Improving signage throughout the clinic to make for a better patient experience;
- Developing a consistent work standard for directly reporting critical results from the lab to physicians.
The RPIW process includes 7-day, 30-day, 60-day, and 90-day follow-ups to review outstanding tasks and deal with any barriers to success that have come up. The 90-day goal is for all abnormal results, as well as normal results for tests that would cause particular concern for patients (biopsies, for example), to be reported to patients within 10 days. This should result in at least 50 per cent of all test results being reported to patients within 10 days.
Some of the follow-on activities that will be reviewed at the 30, 60, and 90-day checks include:
- Working with MedAccess (the EMR provider) to have at least two patient identifiers on all electronic templates;
- Working with MedAccess to reduce the number of clicks it takes to import a single result into a patient's chart (currently 26 clicks!);
- Create work standards to share the scanning and importing workload amongst medical office assistants, ensuring timely review and response;
- Create work standards for physicians to review and sign off on normal lab results within 10 days;
- Implement training schedules to ensure all staff and physicians are comfortable using MedAccess and completing tasks to the agreed standards.
To get to the long-term (12+ month) goal of all results being reported to all patients within 10 days, the team will work with PNHR's information technology and privacy staff to investigate electronic options (email or text) to inform patients of normal, non-urgent test results.
Who's on an RPIW team?
An RPIW's success depends on the team! Here's a quick overview of the different roles:
Sponsor: An executive (CEO, VP, or regional director) who gives the go-ahead to the RPIW project and agrees to support the team throughout. Is a barrier-buster and will go to bat for the team and its work.
Process Owner: Typically the manager or director responsible for the area of work. Provides direction and approves the project's goal and targets. Communicates with all employees involved or affected, and is responsible for the follow-on activities.
Participants: Subject matter experts, willing to bring their experience, ideas, frustrations, and problem-solving skills to the team. Includes at least one patient representative.
Team Leader and Sub-Team Leader: Responsible for planning, logistics, and documentation—the fun stuff! Also responsible for the data collection and preparation that takes place before the five-day event. Leads and motivates the team, and acts as facilitator.
KPO Support: The link to the Kaizen Promotion Office and its past RPIW experience. Ensures follow-on meetings are scheduled and attended. Offers support as needed.
Support Team: The go-team—people able to show up and get a job done as requested by the RPIW team, in a timely way. IT, maintenance, materials management, and others may be involved.