Making the most of a new group practice facility by leaning on process improvements

Anyone who watches HGTV’s “Tiny House Hunters” knows that people are finding happiness in some very small spaces. Buildings with less square footage could also result in high levels of satisfaction for healthcare organizations and their patients.

When University of Minnesota Physicians decided to innovate the delivery of care for our medical practice, we analyzed historical data to gain insight into our space needs. We realized that if we continued to implement process improvement initiatives, we could improve care delivery and the patient experience in a scaled-down facility.

As such, the new University of Minnesota Health Clinics and Surgery Center was designed with just 178 exam rooms, whereas our former facility had 300, a 40% decrease in exam space. The new facility also has no check-in desks and only one patient lobby per floor. The space is designed to be flexible — no rooms assigned to particular providers. Instead, rooms are assigned dynamically according to real-time demands.  

A few months after our group practice moved into the new facility, medical department chairpersons came to me with some concerns. They pointed out that expectations loomed large for this new, smaller facility. The 342,000-square-foot facility was expected to accommodate 37 specialties, an ambulatory surgery center and 1,500 providers and staff. The facility needed to accommodate more than 2,400 unique visits per day. What’s more, practice leaders expected us to grow by 5% to 7% each year.

Making this new, smaller facility work for our practice was a challenge that got my blood pumping. As an engineer who started my career in manufacturing and was trained by Toyota, I am a continuous quality improvement enthusiast. This challenge offered the perfect opportunity for me to flex my performance improvement muscles.  

It is my job to ensure that the organization continues to embrace Lean process improvement techniques, a long-term approach that seeks to achieve small, incremental changes to improve efficiency and quality. More specifically, we acknowledged that the organization could move toward greater efficiency in the new facility by encouraging everyone in the facility to operate under the Institute for Healthcare Improvement’s Plan-Do-Study-Act (PDSA) model, a Lean technique that could empower all clinicians and staff members to make the changes that would increase efficiency and quality in the new building. Through PDSA, all staff members can test changes by developing a plan to test the change (Plan); carrying out the test (Do); observing and learning from the consequences (Study); and determining what modifications should be made to the test (Act).

Digging up the data

To succeed, however, Lean initiatives need to be supported with data. That’s why our practice created Care Connect, a program that combines real-time and retrospective information from our facility’s real-time locating system (RTLS) and EHR.

Data from the RTLS proves especially useful when implementing process improvements, as the system routinely collects real-time data on wait times, space utilization and more. The RTLS specifically provides data that answers questions such as:

• How long are patients waiting?
• How long do visits take?
• How much time do providers spend with patients?
• Are exam rooms being fully utilized?

In addition to using the system to make real-time improvements (see sidebar), the data can be infused into the PDSA process, making it possible to manage a culture of continuous improvement. Staff members can access their data through the RTLS reporting software, enabling them to deploy process improvement initiatives at the front line. The system also makes it possible for performance improvement teams to collect needed data in a matter of a few days or weeks, as opposed to the months that it would take to cull the data through manual methods alone.

Cultivating the changes

After analyzing the data, staff can start to make meaningful changes without relying on process improvement professionals. For example, to reduce wait times and improve room utilization, care providers and managers pulled RTLS and EHR data and placed it in a charter to see the directional indicators that illustrated where patients were waiting beyond the 15-minute mark. When this data was combined with data that showed how long physicians spent with patients in the exam rooms, it was possible to determine how many rooms a care provider needs to be efficient. Staff members were then able to make informed decisions about real-time room assignments and better manage capacity throughout the facility.

Similarly, access to front-line data was useful to medical school residents in one of our specialty clinics. These residents felt they spent too much time idle, waiting for patients. By pulling data, however, they saw that patients also were waiting to see the residents. The fix? By simply reorganizing who goes into the patient room when, the residents reduced the time patients spend in exam rooms by 40%, consequently reducing patients’ total length of stay. They used the RTLS data to identify the root cause and verify that the resulting process improvement achieved measurable results.

Such process improvements have made it possible for our medical practice to operate much more efficiently and to thrive in our new facility.

Consider the following: An observation study at our old offices revealed that exam rooms were only utilized 30% of the time. After implementing a variety of process improvement initiatives, our utilization initially increased to an average of 50%, a 67% improvement. As we continue to refine our workflows with data from the RTLS and EHR, we purposefully created additional capacity, and today room utilization stands at 45%.

That’s just the start. We still have work to do regarding exam room utilization, and we’re embarking on a process improvement initiative to determine where our excess capacity is and how we can realign that capacity to better accommodate patient volumes. Because of these planned improvements, we expect that our facility will accommodate our growing needs as time goes on.

Real data, real-time improvements

In addition to using RTLS data to support Lean process improvements, University of Minnesota Physicians leverages RTLS data in real time to:

• Manage space. We don’t assign exam rooms to providers. Instead, we operate using “first room up.” The RTLS software tell us in real time, using visual management, which rooms are occupied, needing turnover or ready for a patient. We escort patients to the first available room, and again through the RTLS visual management software, providers know where they’re needed next.
• Manage patient wait times. The RTLS monitors the time patients are in the lobby and the exam room. If a patient has waited in the lobby 15 minutes past an appointment time, or is alone for more than 10 minutes in a room, the system triggers an alert. Our clinic managers can pull average wait time data daily. If there are trends, we hold problem-solving events with physicians, leaders and clinical staff to create a more realistic schedule.
• Help physicians manage their time. Often providers need to move to the next patient, but it may be difficult to disengage from the current visit. Through a feature called “Physician Assist,” aka the “Save Me Button,” providers press the button on their RTLS badge, sending a call for assistance. Staff will knock on the door and provide a natural exit point.
• Manage interdisciplinary care. When a patient needs to see more than one specialist, our teams use the system to know who is in the building, connect with them and see if a coordinated visit is possible. It allows our teams to work collaboratively and provide a better patient experience.