Wait Times Plummet
By involving other departments as it untangled a web of issues, this Oncology Clinic has sustained its success for more than 18 months
Department: Oncology Clinic, Moanalua Medical Center, Honolulu
Value Compass: Best Service
Problem: Average wait time for patients from check-in to chemotherapy treatment was 56 minutes, causing complaints from patients and staff members
Metric: Average daily patient wait time
Union co-leads: Mary Jane Kanayama, RN, and Annette Viernes, RN, Hawaii Nurses Association, OPEIU Local 50
Management co-lead: Donna J. Primiano-Holton, RN, nurse manager
SMART goal: Decrease the average daily wait time from 56 minutes to 29 minutes within a month. Once met, sustain the improvement over time.
Small tests of change
• Advised patients to complete physician-ordered lab work at least one or two days in advance of their chemotherapy appointments, if possible
• Recruited medical assistants to help physicians track lab orders and ensure laboratory tests are ordered and completed
• Restricted most same-day appointments to chemotherapy/infusion treatments lasting 60 minutes or less, and reserved a two-hour window for lengthy appointments that could not be postponed due to patient’s schedule
• Staggered patient appointment times to address staffing shortfalls
Results: The team met its initial goal after launching the project in 2011 and then improved further; it has essentially sustained the improvement for nearly 18 months. In the first month, the average wait time between check-in and treatment fell to 29 minutes. In four months, the team’s efforts had decreased the average wait time by 44 minutes, or 79 percent, to an average wait of 12 minutes per patient. Today, the average wait, measured year-to-date in May 2013, is about 15 minutes.
Key to sustaining change
Continue educating patients about having necessary lab tests and paperwork in order before coming to appointment; in addition to outreach letters, this includes one-on-one, face-to-face counseling with members.
Why? Why? Why? That’s what the unit-based team of nurses at the Oncology Clinic kept hearing from patients. With 25 to 35 patients coming in each day and just eight treatment areas, the complaints were piling up, says union co-lead Kanayama.
“Why isn’t my medication ready?” “Why is it going to take so long? I was told I’d be finished in two hours.” “Why haven’t I been called yet?” The nurses started investigating the whys and found many culprits:
- Missing lab results
- Missing chemotherapy orders, or orders that had not been signed by a doctor or nurse practitioner
- Double-booked infusion chairs
- Nurses and other staff pulled away for advice calls
- Pharmacists and physicians on different schedules unable to connect and sort out unclear orders
- Pharmacy staffing that delayed the mixing of chemotherapy medications or getting the required second pharmacist’s verification of the medicines ordered
- Too many patients scheduled at times with low staffing levels, such as lunch
Then the team got down to business. Nurses collected baseline data from randomly selected patients every day. Having identified such a range of issues, they reached out to physicians and to their colleagues outside the partnership, including pharmacists and medical assistants. With each test of change, the nursing team forged new connections and succeeded in getting different groups to help one another: Medical assistants helped physicians keep the chemotherapy orders current, for example, and schedulers coordinated with pharmacy staffing in setting appointments.
“This team has demonstrated the true meaning of partnership,” says Lisa Kane, the team’s UBT consultant. “There were able to identify issues and reach out to everyone seamlessly, working together with the patient truly in mind.”
And with so many different elements to address, the team gained a deeper appreciation of the value of the plan, do, study, act cycle.
“We could not have had this success without it,” says management co-lead Primiano-Holton. “The format really helped us to think things through, and organize our approach, keep our goals in line, and understand why we needed to follow through with each test before going on to the next step.”