Streamlining Patient Access and Registration

When patients are sick, in pain, undergoing procedures, or simply getting routine checkups, they expect their healthcare organizations to deliver quality outcomes using efficient processes. Unfortunately, hospitals and medical facilities, even those with high-quality performance, often have reputations for poor efficiency and notoriously long wait times.

Frustration with the overall process, even when actual medical care is exceptional, can reduce patient satisfaction, possibly reduce insurance reimbursement, and drive patients away to other providers. This situation can be reversed with effective planning and deployment of an operational excellence strategy.

Implement Operational Excellence to Improve Patient Experiences and Overall Effectiveness

The continuous improvement process starts with developing an operational excellence (OpEx) strategy. This will include an assessment of goals, gaps, and needs and the creation of an overall plan identifying the areas to address, defining improvement projects and establishing a delivery timeline. Ideally, the process includes an integrated rollout across the organization with opportunities to quantify ROI or other success metrics, track progress, and identify and address areas of risk that could limit achievement of the goals.

As with other improvement efforts, the process starts with a look at the critical flows within operations. In a healthcare facility, this might include patient access, emergency department throughput, patient placement, patient discharge, patient experience, patient transport, patient room turnover, and operating room turnover.

Patient access and registration may appear early on the list of potential improvement opportunities. These areas are important contributors to patient satisfaction and bottom-line performance and do not require the application of medical expertise to make improvements.

What is the Patient’s Perspective of Registration?

Although the health care facility couldn’t operate without the registration function, from a patient perspective, registration is almost entirely a non-value-added activity. Patients would love to be able to walk into the facility and immediately be seen by a provider, with no extra process steps or waiting time.

Consider potential issues in the registration process from the patient’s perspective, expressed in some of the “8 Waste” terms identified by Lean concepts:

• Standing in line to see the receptionist – Waiting
• Completing many pages of patient history forms for every visit, even when it is the same or an affiliated facility – Excess processing
• Having to provide insurance cards to be copied…again! – Excess processing
• Finding out at registration that fasting was required and having to make a return trip later for lab tests – Excess motion
• Being scheduled to arrive before the doctor will actually be available – Waiting
• Having to stay in the waiting room long after the scheduled appointment time – Waiting
• During extended time in the waiting room catching something from other sick patients who also waiting - Defect
• Answering many of the same questions multiple times, from the patient history to the nurse to the physician – Excess processing
• Being led into the examination room, only to wait even longer to see the healthcare professional – Waiting

Patient Registration Doesn’t Have to Be a Painful Process

Registration is the first interface that the patient has with the health facility. When the patient arrives, the registration process should follow the tenet of the Hippocratic oath, “first, do no harm.” Waiting and frustration added to the discomfort the patient is already feeling, create unnecessary pain. Fortunately, these problems can be fixed.

Registration in a health facility is very similar to transactions in banks, manufacturing, and other operations with queuing steps. Timely access to the health care provider parallels processes with constrained resources. Supply and demand management, queuing theory, constraint resolution, and contingency planning are all likely to be elements of the continuous improvement solution that a focused OpEx project team will put in place. Best practices from industries outside health care are relevant and can be transferred to hospital, clinic or medical office processes. Organizing the projects to address these issues in an integrated fashion can deliver rapid improvements.

Applying OpEx Methodologies to Patient Registration

Deploying OpEx strategy incorporates operating methods, leadership behaviours, cultural change and process improvement tools. Multiple projects are defined to address specific root causes that are uncovered in each problem area. This systematic improvement approach incorporates many tools, from simple to complex, which can help address some of the target opportunities:

• Situational assessment in an organizational flow generally starts with a Value Stream Map, which documents the actual time that each process step takes and notes the “inventory” of paperwork or product at bottleneck steps. In the health care stream, the patients are inventory. Industries, banks, airlines, and other entities have used value stream maps to streamline their processes and improve manufacturing or consumer efficiencies. Just look at the large number of chairs in a health care waiting room to see that value stream and inventory management can also apply in the medical world.
• Observations of the processes in the flow identify existence of Eight Wastes , such as waiting, excess motion, non-utilized talent, and extra processing. These are all things that the patient doesn’t want to pay for in money or time. For example, redundant capture of extensive history is not only time-consuming for patients and office staff; it is also fraught with the potential for errors.
• Building on the value stream information collected, one of the enhancements pursued may include Leveling of the workflow to eliminate bottlenecks. Gathering and utilizing data on patient arrival patterns can help to set up doctor schedules that manage the supply and demand balance. For example, doctors can be underscheduled with routine appointments on Mondays, knowing that post-weekend call-in volume will be high. This will prevent building backlogs and high wait times.
• The doctor is often the constrained resource in health care operations. Removing tasks from the doctor’s routine that could be done by others can eliminate pockets of waiting time. Having the nurse take vital signs is a common demonstration of this approach. This method of Managing Constraints can also be applied to patient registration, for example, by eliminating the time needed for history forms at the office by having the patient pre-register at home.  
• Another Lean technique is 5S (sort, set in order, shine, standardize, and sustain), a team-driven process that organizes equipment and materials in the workplace to minimize wasted time and steps. All requirements can be accessed quickly and accurately when needed for the process. Application of 5S at the registration point of contact can enhance the efficiency of the clerical staff.

Don’t Just Do Operational Excellence. Manage It.

Many of the steps surrounding a patient’s visit to a doctor are not essential to the actual care of the patient’s health, nor are they unique processes. Making an appointment, registering upon arrival, viewing information, paying, and other transactions apply in airline travel, banking, manufacturing, and other widely varying processes. Lessons can be learned from teams that have taken on the challenge of achieving operational excellence in diverse industries.

The difference between success and failure in operational improvements often depends not on technical expertise, but on management approach and effectiveness. Knowing how to prioritize projects, measure current and improved performance, and tie progress to overall scorecard objectives can be extremely important.

EON has extensive experience working with a broad range of enterprises on implementing operational excellence. EON teams have developed a flexible solution that can help keep processes organized, ensuring continued long-term success in OpEx improvement efforts.

With the nation facing an aging population and ever-growing health care costs, it’s vitally important that every facility take on the challenging but rewarding effort to improve operational excellence in areas such as this. Continuous improvement pays off in patient satisfaction, medical facility assessments, and financial performance.