By Peter Do
When Dr. Tim Gray started Mountain View Medical Center in 1990, he was committed to providing first-rate medical care. Patients trusted Dr. Gray and his team to prioritize their health—but patient waiting times were rarely a topic of discussion.
Then, Dr. Gray received a compliment that was a bit of a double-edged sword: “Appointments here are like fine dining. It takes forever to get a table, but the food is amazing.” Yikes.
When David Swartout, Director of Operations at Mountain View Medical Center, first entered the practice 10 years ago, he knew something needed to be done. “I had a feeling some processes could be improved,” says Swartout, “but we needed the data to back it up.” Armed with a background in intelligent supply chains (using data to improve processes within an organization), he set out to do what few practices have done before in regards to patient waiting times: remove the non-value add time out of clinic workflows. Today, patients are seen in just over 2 minutes on average, and the level of care has never suffered as a result.
Here’s how it happened.
Reducing Patient Waiting: A 9-Month Audit
Swartout set out to audit the processes in place at Mountain View Medical Center and see how the team could reduce patient waiting times. The practice enlisted the help of nearby Pacific University, which offers a Master of Healthcare Administration program full of students looking for relevant clinical experience.
MVMC hired a student to study the patient lifecycle while in the clinic. “This student literally sat in the waiting room with a stopwatch timing how long it took to complete the check-in process.” In addition, the student diligently followed around hundreds of patients to gather data about what went on from the moment they walked through the doors. How long did it take, for example, for a patient to enter an exam room? To see a nurse? To see a doctor? To get an x-ray? She discovered that patients were waiting an average of 15 minutes and 20 seconds, basically sitting by themselves, before anything really happened.
Unsurprisingly, patients could spend well over an hour at Mountain View Medical Center, and modern patients have little tolerance for high waiting times. “So, we tore apart our workflow,” says Swartout, “auditing each and every process to see if it was really necessary, or if anything should be completed in a different order. It was a real team effort.” For example, the team focused on:
- Patient check-in forms
- Tweaking the scheduling system
- Reordering certain processes
- Restructuring the lab
- Changing the process of assigning patients to exam rooms
- Changing the order in which doctors saw patients
- Making small changes—like ensuring patients never felt lost in the office
MVMC even did some internal construction, tearing out a couple of walls and moving one of the nurse stations, all in an effort to improve patient workflow. In fact, Swartout’s office is part of the old waiting room! (They realized they were no longer using 1/3 of the space).
The Results: Lower Patient Waiting Times and High-Quality Service
After 9 months of restructuring processes, the doctors heard another unexpected “compliment” from a patient: “I’m so sorry to see you’re closing your doors. There’s never anyone in the waiting room anymore.”
The MVMC team was thrilled to hear this.
It had, in fact, been one of the practice’s busiest days, and the reason there was no one in the waiting room was that patients no longer had to wait.
In the past, patients waited an average of 15 minutes and 20 seconds. Nine months later, patients were seen in just over 2 minutes––and this is still true today. In fact, they rarely have a chance to sit down. “Patients bring along books to pass the time, and they’re surprised when a doctor enters right as they open the cover,” says Swartout. “The doctors often joke, ‘I can come back later if you want!’”
On their busiest day, Mountain View Medical Center might see 100+ patients, but they are always focused on the patient’s needs, first and foremost. They still get seen on time and receive the quality of care they’ve come to expect.
Sustaining the Progress They’ve Worked For
Years ago, Dr. Gray and his team were excited to see 20 patients a month. Now, they’re en route to see 300 patients a month.
Swartout credits a lot of the continuing success of Mountain View Medical Center to the marketing efforts of Healthcare Success, as well as the continuous checkups his team makes to ensure processes run smoothly. Staff members are often assigned to “be a patient” for the day, walking through the process for themselves to recognize inefficiencies. Mountain View also frequently consults its PFAC (Patient and Family Advisory Council), which is made up of a diverse group of skeptics and supporters.
Another way Mountain View manages high patient intake numbers is with their “$100-for-100” program. This began during the early stages of Mountain View’s transformation when new patient numbers were hovering around 85 a month. The staff felt that new patient intakes were a lot of work. “So we offered the staff a crispy $100 bill when monthly new patient intakes reached 100,” Swartout says. The staff ran with the challenge, and the team will begin the “$300-for-300” this year.
“Moving from 100 to 300 new patients a month,” says Swartout, “is like drinking from the firehose. It may work for a while before things slowly start to unravel.” It takes teamwork and vigilance to maintain a steady intake system and ensure everything continues to run smoothly. But it can be done.