I'm on time! Where's my doctor?

September 2015

The Clinic On-Time Starts Project: Shifting the Focus Back to the Patient

Patients and their families are usually unaware of process improvement initiatives, but at Children’s Hospital Colorado, one project in particular has made a significant difference to patient satisfaction.

Back in 2012, Chris Martin, FACHE, vice president of ambulatory services, received feedback that suggested the number of appointments that started on time was unacceptable. (Chris Martin, pictured at right.)

“We discovered that just 33% of our visits started on time in 2012,” Martin said. “Thus the Clinic On-Time Starts Project was born. We started by looking at the percentage of on-time starts for the first appointment—morning and afternoon—of every provider in every clinic.”

An appointment is classified as starting on time when a care-team member is in the examination room with the patient within five minutes of the start of the appointment time. Patients who arrived late for their appointment are excluded from the data.

Challenging Perceptions

“Our first step was to present the findings to our teams, to break down common misconceptions,” Martin said. “For example, many clinic and ambulatory team members believed that all patients arrived late for their appointments. This meant that they were often late, too. Yet the data shows that over 80% of patients were actually on time or early.”

David Brumbaugh​, MD, assistant professor of pediatrics, has been involved in the On-Time Starts Project since its inception. He explained how such a misunderstanding could arise.

“There are a lot of other things going on in a hospital in addition to patient appointments, such as meetings and medical research,” Dr. Brumbaugh said. “This project is about changing the institutional culture, and making sure the focus is always on the patients.”

Yet this initiative works in physicians’ favor, too. “My whole day is sunk if I start late,” Dr. Brumbaugh said. “When I am able to stay on schedule it makes my life so much easier, and allows me to provide better overall care. What’s more, when everyone is on time there is a definite lift in workplace culture and morale.” (Photography by Scott Dressel-Martin, Children's Hospital Colorado)

Boosting Satisfaction

Indeed, the overall goal of the Clinic On-Time Starts Project is to boost the care-team and patient-and-family satisfaction ratings, although that can be hard to measure.

“When you look through the comments made by patients over time,” Dr. Brumbaugh said, “they often say things like, ‘We had a great experience but did our appointment really have to take up half a day?’ Now patients and their families are very appreciative when you start on time. It shows you appreciate their time and understand that there’s an opportunity cost for the time they spend at the hospital.”

“The Clinic On-Time Starts Project is one of the initiatives that mean that when you come to Children’s Colorado, it’s not going to be some kind of interminable academic experience, where patients are treated as though they should feel privileged to be here. If you start from that place, you’re not valuing the patient or their family.”

Measurable Results

The results achieved by the Clinic On-Time Starts Project over the past three years are significant.

“By the end of 2012 we boosted our on-time start rate from 33% to 77%,” Martin said. “In 2014 we achieved a rate of 84.4%, and by the end of 2015 we’re planning to perform even better.”

Associate Dean for Clinical Affairs, Child Health and UPI Medical Director-Child Health, Michael Narkewicz​, MD, explained that the project is a great example of clinic medical directors partnering with ambulatory leadership to improve the patient and provider experience.

“We have had great success with the ambulatory clinics now achieving 85–90% on-time starts for the first patient in clinic,” he said. “This has worked so well that our spacious waiting rooms are virtually empty most of the time and we are beginning to look at how we can use some of that space.”

Yet there is still a way to go before the Clinic On-Time Starts Project can reach 100%.

“We learn about new opportunities to improve constantly,” said Martin. “We’re working closely with providers to reduce the amount of time they need to spend documenting their visits in Epic. We also want to improve Epic timestamps so we can capture data points throughout the day, not just the first a.m. and p.m. appointments.”

Martin is also planning to improve the scheduling templates. “We want to be able to measure how long patient visits really last, so we can allocate the right amount of time for each visit,” he said.

Success through Effective Communication

Though there are still improvements to be made, the Clinic On-Time Starts Project is a shining success-story of interdepartmental process improvement. The team has seen dramatic results by aligning their goals throughout the organization and communicating effectively at all levels.

“Everyone—from the clinic medical directors to the process improvement team to the practice directors and managers—has the same goal,” Martin said.

Dr. Brumbaugh agreed that the streamlined, focused nature of the Clinic On-Time Starts Project is the key to its success.

“We learned from this project that transparency is the driver of change,” he said. “When everyone’s on-time starts were published, they could see the context around how they were doing and how they compared to their peers. This works: If you’re substantially behind everyone else, it stands out and you don’t want to be there.”

“Ultimately, it’s hard to measure culture but there’s a shared understanding among all members of the health care team that this is a very valuable initiative, and one that’s in the best interest of the patient.”