The QI team initially took this project on. During the Kaizen event, several things arose that the team did not think about before the event. The billing/administrative staff member pulled a list of missed appointments and made an alert flag in the electronic medical record (EMR) to identify chronic no-show patients. The front desk staff were brought in to discuss changes with scripting for reminder calls and follow-up calls for patients who miss appointments.
The QI team hoped to eliminate barriers to patients coming to their appointments and to identify trends. The dental center manager, environmental health specialist, and a front desk staff member completed a Gemba walk. From this, they created a training manual for administrative staff to use when registering patients. Standard work became a huge focus for MCHD during the initiative. The team lead created a survey for staff and customers related to reasons for patients missing appointments. During lunch on a day of the Kaizen event, nurses were brought in (including the family planning program coordinator), and their input was obtained. The FNPs were also consulted for feedback. The QI team decided to double-book on 2 days a week in the mornings to accommodate missed appointments. The billing administrative staff member edited the schedule template to allow this. This QI initiative involved six team members, the health director, the DON, and the administrative officer. All staff members were also informed of this initiative via a staff lunch. Three nurses, two FNPs, and two additional administrative staff members were involved with input about changes. FP clients were also surveyed via paper and telephone. Information about this project was also presented to the Board of Health.
Other results of the QI project included the following: work was standardized; scripts for “common language” for reminder calls were used; a registration manual with images for a streamlined process was developed, and all administrative staff will be trained to address staff concerns; a call log and waiting list with clear directions were developed; a resource guide for the social and physical needs of clients was used; office staff (registration and clinic staff) will receive a notification of “no-show” patients; and log sheets are available to record and analyze potential trends (e.g., weather delays, holidays).
Sample of materials produced