Workflow Quality Improvement

The goal of this project is to identify areas of improvement at the University of Kentucky’s Markey Cancer Center’s Comprehensive Breast Care Center (CBCC) on managed quality workflow. The CBCC ultimately aspires to provide breast care patients with reduced procedure times, and transparent cohesive patient location. This project will display an overview of the process; the communication difficulties, challenges faced with morale, and provided recommendations for improvement. The information collected resulted in several recommendations, the implementation of a moral committee, another was the implementation of a new patient tracking system. These outlined improvements should vastly increase clinical operations but as well as patient-centered
care. It is the goal that after the implementation of these improvements that they should run out to all the remaining clinics in Markey’s network to efficiently tack patients and highlight any inefficiency in workflow by length of stay.

Background
The UK HealthCare Markey Cancer Center’s Comprehensive Breast Care Center (CBCC) is nationally known for the revolutionary care they provide. The center offers a full range of services, including routine screening mammograms, second opinions, diagnostic workups, genetic counseling, and advanced treatment options for breast cancer. The CBCC was the first health care facility in the state of Kentucky. Currently, the CBCC sees approximately 1,600 patients per month and performs nearly 4,000 procedures and 30 breast surgeries.
The purpose of the study is to find inefficiency within workflow to maximize the efficiency. Specifically, this study will address the problem that focused around patient-centeredness care. Wait time and patient tracking communication are the areas of importance where the CBCC would like to improve efficiency. The targeted problem currently, is the CBCC is using a status board (SCM) which does not give and accurate account for how long a patient has been at the clinic or their location within.
A typical workflow occurrence with a patient could have a patient in a minimum of four different locations within the clinic or a max of seven. Some patients have been known to be in the clinic for longer than a few hours at times. Crystal Kendrick (2017), Practice Manager of the CBCC expressed her concern with the current efficiency workflow. “One thing that I want to address is that if Dr. Karpf’s office called and asked where a patient was and how long they have been waiting in our clinic, I want to have that information rapidly available and clearly tracked to provide.” She stressed that is only done if we have an exact systems to provide the information.
Ashley Ackerman (2017) Sr. Patient Services Coordinator, conveyed concern as well with wait time and having access to care for more patients to receive services. “If we are able to learn where the inefficiency are, within the clinic we can better address them. This will allow us to see set of standards, as well to see if we can increase the amount of patients we are able to see based on the running efficiency of each area.”
Literature Review
When working within a clinic workflow efficiency is one of the most observed task to look for improvement.
The different ways to look at workflow efficiency, would be though the view of patient wait times. New system implementation, as well as new equipment which helps in procedure processes. A study was completed that discussed Clinical Workflow Efficiency stated how “Traditional strategies to manage workflow complexity are based on measuring the gaps between workflows defined by HCO administrators and the actual processes followed by staff in the clinic. However, existing methods tend to neglect the influences of EMR systems on the utilization of workflows, which could be leveraged to optimize workflow.” (Chen, 2015
n.d)
The text on Healthcare Management Science:
“The appropriate design and management of workflows can significantly improve efficiency of clinical treatment, care quality, patient safety, and care decisions. Good management of workflow efficiency can improve quality of clinical care and reduce costs of patients. By providing HCOs with such knowledge of workflows, we anticipate healthcare administrators will be able to optimize the efficiency, as well as minimize the complexity of workflows in a more productive manner.”(pg. 42)
AhiQa systems with all of it functionality is the right time of new technology that the CBCC could use to address inefficiency in workflow. Approved for use by UKHC senior officials for organizational use, AhiQa has never been used in a small clinic like the CBCC which headlines registration as one of its focal point in patient centered care. According to McKesson RelayHealth (2014) “Today RelayHealth Financial announced that AhiQa, its patient access and registration QA solution, has earned “Category Leader” recognition in the “2013 Best in KLAS Awards: Software & Services” annual report. This latest honor marks the third straight year that AhiQa has been named the Category Leader among “Patient Access – Registration QA” vendors.”
Debbie Ashlock-Jones, is an Administrative Admitting Coordinator for UKHC and solely administrates AhiQa and its training to all staff within UKHC.
Debbie (2017) said the AhiQa is one of those systems that is better than Sunrise Clinical Management (SCM) which is what current smaller clinic are using because of it real time tracking and customized reporting function.” With these customizable reporting options, you can pin-point multiple inefficiency with in workflow on a real-time basis.
It is the understanding that having updated technological equipment also improves efficiency workflow. Ashley (2017) recognized this in her capital request for Hologic’s Trident Specimen Radiography System she cites Hologic in saying “Its high image quality, combined with easy-to-use software, offers reduced procedure steps and improved workflow.”
Hurdles of Implementation The transitioning from Sunrise Clinical Management (SCM) to AhiQa systems will be a challenge that would require staff, nurses, and radiology tech work. The implementation to AhiQa systems requires full clinic training. It is understood that, to see the effects of efficiency workflow patterns have to change. The shift in programs requires update of software, standards, and practices.
Procedure
The study was conducted through AhiQa systems. A needs assessment was preformed to understand the inefficiency per area in the clinic (Registration, POD nurse/physician area, Mammogram Tech). By the information presented in needs assessment chart was filled out that out lined area of concern. When looking at registration we timed check in, and registration. For the Mammogram Tech area we looked at time of how long a patient waited in dressing rooms, the length of procedure, nurse teaching prior to mammogram or ultrasound procedures. As for the POD nurse/physician area, we looked at the length of time a patient was in the triage, with provider and nurse teaching.
Once the results were recorded, an outline of practice was recorded to gain an understanding of what is being taught and how we can provide the information in a more effective way to patients without decreasing patient center care. Reports were run weakly to monitor the changes in efficiency by a way of decreased total time duration at the clinic.

Project Timeline
• Conduct a need assessment of the different areas of the clinic (January 2017)
• Receive approval UK Senior Leadership to move from SCM boards to AhiQa Lobby (January 2017)
• Clinic staff training of how to use AhiQa lobby (February-March 2017)
• Implement AhiQa Lobby boards to the clinic (March 2017)
• Review AhiQa Lobby to prove efficiency in workflow and patient access to care impact (April 2017)
• Preform a F.O.C.U.S analysis of the areas that that have lower efficiency of workflow (May 2017)
Results
Project Assessment
The feedback received form the clinic staff as well as senior leadership has been positive for the project. Many of the early concerns with the previous systems was the lack of detail and communication. With the implementation of SCM staff expressed how the lack of specificity in waiting time caused patient-center care satisfaction to decrease. I would push that the study continues, and even conducting a PDSA FOCUS of the areas with the lower efficiency of workflow.

Recommendations

As a direct result form information collected through the time of the study, the recommendations are submitted for consideration by Markey Comprehensive Breast Care Center.
1. Continued use of AhiQa over SCM as a status board
2. Nurse teaching standard
3. Transparent communication