As the saying goes, you never get a second chance to make a first impression…including in health care. With patient experience now directly correlated to clinical and business outcomes, it’s increasingly important for health care organizations to favorably impress patients at the outset of their care. An excellent way to begin is by providing patients with more efficient and streamlined front-end processes, such as those related to registration and patient flow.
That’s precisely the approach taken by a leading California health care system, which created a new and more streamlined registration process for cancer patients requiring multiple same-day services (e.g. office visit, lab, x-ray) at the system’s cancer center. Previously, the system’s patients and their caregivers often had to complete multiple registrations at each point of care in their visits. Registration was set up and run more for the benefit of the staff than for patients’ convenience or satisfaction. Patients correctly saw these multiple registrations as non-value-added time – a critical factor to those with cancer – and voiced their displeasure to the health system’s administrators.
Clearly, the health system needed to create a more patient-friendly registration process at its cancer center – no easy task, given the 400 to 450 patients seen each weekday at this facility. The health system decided to create a one-stop universal registration process for its cancer patients, and turned to Freed Associates (Freed) to help coordinate and launch this effort.
Due to the cancer center’s daily volume of patients and the inherent technical complexities of changing existing registration processes, the health system and Freed immediately recognized the need to make registration changes incrementally, as follows:
1. Define and refine the proof-of-concept: Use existing patient registration data and new information gained via patient feedback (e.g., “How can we improve your registration experience?”) to determine what registration-related changes and process improvements should be made.
2. Conduct an initial pilot program: Determine a suitable operational subset to pilot the new universal registration; collect and assess data.
3. Implement a broader, revised effort: Based on feedback from the pilot program and changes made, roll out a revised registration process to a larger segment of operations.
By taking this step-by-step approach, the health system and Freed sought to examine current workflow patterns, identify opportunities for improvement, gradually make operational changes without detracting from clinical care, educate and train staff and clinicians, and roll out a finalized process facility-wide.
Survey and Data Gathering
The health system and Freed began by soliciting and collecting input from a council of cancer center patients and their families. This group’s participation was invaluable for helping the registration design team understand the interests and motivations of patients and their caregivers. For example, from the council’s involvement, several changes were made to the design of the universal registration system. Additionally, council member ideas influenced staff scripting about the new registration system.
Freed also gained key ideas from staff members and clinicians on the “front lines” of the patient registration process, including employees within the health system’s Patient Access Services department. Getting this input also helped spur employee support internally for implementation of the new universal registration system.
The registration design team also factored in vital contextual information which would influence the final design of the universal registration system. This included plans for the health system’s future operations and growth and ways to potentially eliminate process-oriented waste and redundancies (based on lean process methodologies).
With its universal registration process, the health system wanted to provide cancer patients with a “one-stop shop” to simultaneously allow patients to be automatically registered for all of their other appointments in the facility that same day. The health system and Freed sought to understand the cancer center’s current state regarding registrations, using metrics such as average patient visit volume, and determine the average amount of wait time and clinical time experienced by each patient.
The health system, with Freed’s input, also needed to resolve several associated technical challenges, such as those around patient billing and tracking. For example, once a patient is initially checked in and registered, how could the cancer center continue to monitor and track this patient’s progress and location – without the patient having to check in again?
To resolve this need, the health system implemented a real-time patient location system. At initial registration, patients would receive a small laminated patient location badge listing a bar code number specific to that patient. As patients with their location badges traversed through the cancer center, the badges transmitted this information in real time to sensors positioned throughout the facility. Clinical staff could then immediately see the location and likely arrival status within the facility of their patients.
Ultimately, the health system and Freed worked with representatives from a variety of hospital departments and on a correspondingly large number of topics, including those related to facilities, safety, privacy, workflow, training and marketing. The system and Freed collaborated on creating and implementing three key technology changes and four key process changes, as noted below.
Key Technology Changes:
1. Implemented updated POS devices and e-signature pads
2. Optimized Epic workflow (department appointments report notification systems and consolidated co-pay collection workflows)
3. Installed patient location sensing technology (patient location badge, sensors, display monitors)
Key Process Changes:
1. Initiated pilot projects to demonstrate proof of concept and make implementation scalable
2. Conducted staff training (clinical and non-clinical)
3. Created patient education and orientation materials
4. Instituted key performance indicators reporting baseline and tracking for performance measurement
Results and Conclusion
The planned sequential rollout of the new universal registration process was a success. Besides eliminating the need for multiple registrations, the new process achieved a 70% reduction in patient registration time, from an average of 7 minutes, 30 seconds to just 2 minutes, 17 seconds.
Patient and clinical staff response to the new universal registration system was widely affirmative. In the highly competitive health care marketplace, having a positive reputation is critical for business success. Based on the accomplishments of this implementation, the health system planned to roll out universal registration at other clinical facilities in its system, as well as begin marketing universal registration as a point of competitive differentiation to new and existing patients.
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