One Referral, So Much Time: Maximizing Efficiency in the Nurse Family Support Services and Oregon MothersCare Referral Process

From May through June 2016, several meetings were hosted with QI, NFSS, and OMC staff to map out the current state of the referral process, identify waste and problems in the current process, prioritize problems, determine the root causes of each concern, brainstorm solutions, prioritize solutions, create a future state process map, and test solutions. The storyboard (attached) shows the process maps. To remedy the confusing process, as identified by root cause analysis, a new standardized process was created via process mapping. The new process was documented, and all staff were trained. To decrease documentation redundancy and the number of systems used, NFSS and OMC phased out former systems and tracking forms in favor of EPIC/OCHIN referrals (where possible) and the internal referral system for all other referrals. The OMC staff member and another staff member agreed to assist NFSS with referral coordination, which decreased the number of contact points for clients. To improve off-site documentation, all NFSS and OMC staff were given a WiFi hot spot and training and assistance in how to use EHR systems off site. By phasing out former systems, including an Excel tracking sheet, in favor of systems that automatically track referrals, data around referrals improved.

Before implementing solutions, DCHS staff determined the time it takes to process a referral, the number of steps in the referral process, staff satisfaction with the current process, and the percentage of referrals tracked. These same measures were reviewed after implementing solutions.