Dr Ruth Demian runs a busy family practice with a complex patient panel, including many elderly patients. Despite her best efforts to balance her appointment schedule and workload, she frequently found herself running behind in her day and keeping her patients waiting. Patients were complaining and Dr Demian was leaving the office late each day, spending at least an additional two hours on paperwork at home every night. Feeling frustrated and burned-out, and wanting to serve her patients in a more timely way, Dr Demian reached out to Shefali Raja, Regional Support Team (RST) member with the Practice Support Program (PSP) at Doctors of BC.

“Definitely having an independent expert—and, simply, a fresh pair of eyes—was very helpful in seeing barriers to the office running smoothly,” explains Dr Demian.

Dr.Demian at desk in office

The Facilitation Cycle

Shefali supported Dr Demian and the clinic team to work through a quality improvement (QI) facilitation cycle, incorporating the following steps:

  • Building on support for, and participation in, the Phases of Panel Management and other PSP services that have helped to reduce overall workload.
  • Completing an Electronic Medical Record (EMR) functionality assessment.
  • Organizing a review of current team communication processes and roles.
  • Creating an aim statement to define their goal.
  • Identifying baseline and post-intervention measures for planning improvements.
  • Embedding newly refined and standardized procedures into daily workflows.

Clinic workflow improvements

Dr Demian and her team implemented a number of changes to clinic workflow related to patient visits. This began by defining clinic staff roles and ensuring patient visit information was clearly documented in the EMR schedule when appointments are booked.

The clinic now sends a patient education letter to new patients explaining that each appointment lasts 10 minutes and covers one to two problems. For existing patients, the clinic staff ask the reason for the patient visit when booking an appointment. As staff accompany patients to the exam room, they advise patients to book new appointments for any additional issues. The clinic also created customized visit templates in the EMR to reflect visit types and support easier documentation and completion during the workday. For example, the medical office assistant (MOA)—who now knows the reason for each visit—opens a new patient visit template and documents aspects of the visit that would be helpful for Dr Demian. When it comes time for the visit, the template and the EMR CDS triggers reminders that show up when a visit is opened by Dr Demian.

Clinic staff implemented a new follow-up appointment booking process, which encourages patients to book their next appointment (if needed) before leaving the clinic.

A 10-minute huddle between Dr Demian and her MOA at the end of each day now enables them to prep for the following workday with ease.

“The huddles are really helpful in improving our workflow,” says Dr Demian.

PSP worked with Dr Demain and her MOA to use the MedAccess appointment schedule for patient visit bookings, and created a customized document for Dr Demian called “visit type and preparation” for this process. Dr Demian explains: “The system keeps us on track, and ensures clinic staff are able to work at the top of their scope with a clear knowledge of their roles and responsibilities.”

Finally, Dr Demian and her team refined and standardized all of the new procedures and embedded them into the clinic’s everyday practice. 

Dr Demian smiling with patient at front desk of clinic

Results and efficiencies achieved

The work undertaken by Dr Demian and her team started paying off right away.  They achieved the following results between May and September 2019 after implementing the clinic’s workflow changes:

  • Average patient wait time reduced by 64% from 55 minutes to 20 minutes
  • Average visit time duration reduced by 66% from 25 minutes to 15 minutes
  • Average paperwork time reduced by 25%  from 2 hours to 1.5 hours
  • Number of times going in and out of patient visits reduced by 50% from 2 - 3 times per visit to 0 - 1 time per visit.

These improvements mean that Dr Demian’s patients are happier with reduced wait times for appointments. Dr Demian is now leaving work on time and doing less paperwork at home. The clinic’s EMR is optimized, team communication and morale have improved, and the clinic’s MOA feels valued and is clear on clinic roles and expectations.

Dr Demian credits PSP’s support in implementing the clinic’s improvements. “Shefali is very solution focused,” explains Dr Demian. “She helped our team work through some excellent SMART goals, and thanks to her support the office is running much more smoothly. Shefali went above and beyond as always!”

Dr Demian and her team are now working on approaches to sustain their work. They continue to build on the improvements they’ve realized by exploring new opportunities for practice improvements with PSP.

Visit the PSP website for more information on practice facilitation support.