American College of Healthcare Executives 2018 Poster SessionStrategic Innovations to Meet the Demand of the Cyber Era

Mario E. Zamarripa, MBA, Mary Dyson, Andrea Knapp, Barbara Hicks

Mayo Clinic, Phoenix, AZ

© 2018 Mayo Foundation for Medical Education and Research

AnalyzeAnalyze PDSA Cycle 1 and 2

SIPOC+R PROCESS

Process: Online appointment request Owner: Central Appointment O�ce

Objective: Increase appointments scheduled due to a faster turnaround time and eliminating unnecessary phone calls

Step 1• Review online request for medical concern and insurance

Step 2• Search for patient in HealthQuest, Schapptbook, and Synthesis

Step 3• If patient has an

insurance that is not acceptable for an appointment in the desired department or indication is not addressed at MCA, deny appointment

• If insurance and indication are comptaible to Mayo guidelines, schedule appointment

Step 4• For Denials Only: Copy/Type email address into the appropriate denial template, change signature , change from email to ARZ CAO Online Request, and send

Step 5• Update subject line with outcome of request

• For Completed/pending/denied requests: Move online request to the appropriate folder

Step 6• Enter appointment

scheduled or denial in Demand Tracker

Supplier

• Mayo Clinic• Appointment

Specialist

Input

• Computer• Internet• Microsoft

Outlook• Online Request• Online Folders• Denial

Templates• Guidelines• Schapptbook• Insurance List

Process

• Determination of appointment or denial (See steps 1-6)

Output

• E�cient response of appointmentrequest

• Eliminate unecessary phone calls

• Increase in number of appointments scheduled

Customer

• Potenial patients who submit an online request

Requirements

• Meets initial appointment requirements

Strengths - Capability to send denial messages quickly without attempting to reach the potential patient via telephone

- Easy/Approved templated messages

- Dedicated sta� to working online requests without interuption of incoming phone calls

- Ability to communicate with patients who submitted an incomplete online appointment request

Weaknesses- Limited resources to provide quality assurance of the new work�ow.

- Time and number of attempts to contact patient to deliver a denial message.

Opportunites- Increase conversion rate for appointments booked

- With dedicated sta� working online requests, we are meeting/exceeding enterprise TAT (72 hours)

- Eliminating unecessary phone calls

- Meeting the needs of patients who prefer to communicate through an electronic platform

Threats- Risk of emailing the wrong person because of an invalid email or employee error

- Email not listed on online request

- Online request submitted on behalf of another individual

-Employees and/or patients deviating from the established work�ow

S.W.O.T.

Analysis

Our time study …. Revleaved an decrease of 2 minutes and 59 seconds based upon the 10 observations.

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Old process Email Response

Series1

Impact/Effort Grid

EffortEasy to Do Difficult to Do

Do 3rd, detailed planning and work

Just Do It

Maybe some dayJust Do 2nd if impactful

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1. Outbound Email Templates

2. Drop down option for patients while filing out online request to select their insurance provider.

3. Online chat representatives to assist while potential patient submits online request.

4. Text Message Response to online request submission

5. Working online submissions using FIFO & LIFO model.

Defi neBackground: Mayo Clinic’s brand is synonym of world class healthcare in every specialty with access to state of the art technology and research. Mayo Clinic’s commitment to its patients goes above the delivery of healthcare, and ensures an unparalleled patient experience. On a yearly basis the Offi ce of Access Management at Mayo Clinic Arizona receives over 25,000 online requests with an increasing rate of 25% year over year. The growing demand caused an increase in the response time and maintained the same request to appointment conversion rate.

Objective: Improve response time from 96 hours to 48hours and increase appointment conversion rate by two percent, by April 1st, 2017.

Planning: The initial baseline measurement revealed a 38% request to appointment conversion rate in March 2016. The sample size consisted of 1,412 online requests. During the analysis it was discovered that on average two percent of the request were not converted due to the timeliness of the response. The process improvement team decided to review all online appointment requests that were submitted from March 1st to March 31st 2017. The counterbalance that was utilized for this project was collected based upon staff satisfaction and patient satisfaction. Patient satisfaction was measured based on the speed of answer and call abandonment rate. The average speed of answer in 2016 was 1 minute and 12 seconds with an abandonment rate of 4.3%. The employee baseline satisfaction score was 3.34 in a Likert Scale of 1-5: 1 being Very dissatisfi ed and 5 Very Satisfi ed.

Team Members

Amy D. Crawford

Mary K. Dyson (Team lead)

Barbara M. Hicks

Matthew D. Plumb

Elaine A. Reed

Jacqueline N. Smith

Mario E. Zamarripa, MBA (Quality Coach/Team Lead)

MeasureOnline Pre-Implementation Survey Results

ControlOnline Post-Implementation Survey Results Results:

At the completion of this project the following results were achieved:

• Increased conversion request to appointment conversion rate from 38% to 41%

• Response rate, excluding weekends, from submission averaged 36 hours include the base line data

• Reduce the number of incoming calls inquiring about Online request status by 27.5%

• Implementation of a hybrid model utilizing the First In First Out and Last In First Out strategy allowed managing these requests to achieved over 80% response time within 24 hours

• 41% of all observed requests (n=2325) converted to an appointment with a response time less than 36 hours, this is statically signifi cant from baseline (.38 VS .41 p-Value=0.00).

Increased staff satisfaction from 3.34 to 3.73

Lessons Learned

• Discovery of additional features with the current IT infrastrructure allowed for electronic communications to be delivered vs a call to the requester

• During the initial phases of implementation the Call Center experienced a decrease in service levels

• Requesters are impressed with same day service and scheduling after submission

ImprovementPre-Implementation versus Post-Implementation Upon analysis of the data the current turnaround

time for an online request was 5 days from patient submission. The staff in the Central Appointment Offi ces was primarily focused on taking incoming phone calls on Mondays and Tuesdays without any focus on the incoming online requests. Work assignments were restructured to give the same priority for online requests as incoming phone calls. This revision allowed for three designated employees to work online requests on a weekly rotation with minimal incoming phone call interruptions. The team implemented a strategy where two employees immediately addressed requests as they arrived and the third person worked the oldest requests. In observations with the staff, the improvement team discovered that the following factors affected the response time to online requests:

• Staff continued infl ow of incoming calls and diminished the prioritizing of online requests

• A strong correlation was found that as time progressed from the submission date, the number of attempts to reach the requester increased while the probability of conversion decreased. This resulted in multiple calls/voicemails without resolving the appointment request

• Denial responses required a phone call to deliver the message with a reach rate of 17% in the fi rst attempt