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In-hospital procedures, inefficiencies cost both time and commitment. Furthermore, they can cause medical errors, frustrate doctors, workers, and patients, cause damage, and decrease productivity (Backer, 2002). Regardless of the dire implications, several attempts struggle to address these workflow constraints, wastes, and redundancies. Many charged with the task of reforming service delivery are unable to see past the pattern of doing things; in other words, the difficulty of current medical practice prevents them from seeing opportunities for doing things better and more efficiently (Backer, 2002). This paper opens the common inefficiencies in service delivery to patients beginning by touching three key areas: front office, back office, and the physician.
The front office
The front office is the first department that needs examination. It is the place where numerous activities take place which includes the following: new patients handling in paperwork, patients clear out, booking of appointments for laboratory tests, faxes, mobile phones ringing, etc. It comprises of the following components.
The communication/phone system: It forms the entry point into service delivery in the hospital setting. Inefficiency at this stage can distress and irritate patients a situation which consequently can lead to poor productivity as the employees try to counter the adverse effects. The telephone system is the starting point of scrutiny for inefficiencies. As the chief experience officer, one should determine the optimal number of phone lines your staff should answer (Backer, 2002). Besides, a determination must be done on the number of phone calls an officer in the call centre should respond to at a particular time. In case there are more than two phone lines an officer should answer, potentially there are is a serious problem. More than five phone lines connected to a single customer care desk is a disaster. At worst all officials at the client's office should have at most one call on hold at a time. Anything above one is a disaster; the hospital will lose callers and finally patients (Backer, 2002).
Messages: the passing of right messages to relevant departments in the hospital is one of the most critical duties of the front office personnel. An incorrect message is both disastrous and aggravating. Customized color-coded papers where different colours represent different types of queries is recommended for messages which must be communicated through the papers (Backer, 2002). Personalized slips with various colours signify particular department which needs to attend to the patient. For instance, a patient needing assistance from the pharmacy should be represented by a different colour from one who needs to see the physician. The chief patient experience officer needs to determine whether there are staff members who need to leave their desks to deliver urgent messages to various offices. Besides, the consequences of leaving callers hanging must be determined. For instance, it may lead to the need for some employees to work overtime and hence more costs to the hospital (Backer, 2002).
Inefficiencies from paperwork: it happens because officials at the desk must process all information to do with the new patients. It may appear that sending out forms for new patients to fill is costly, but it is money economically used (Backer, 2002). In case that the forms sent out include information to the hospital, it can aid in reducing chances of patients arriving late at the hospital or completely fail to show up because they could not find a space in the parking lot or they got lost while trying to locate the direction of the hospital. Sending patients registration forms earlier can save a lot of cost and time as there is not wastage of time filling personal details after arriving at the hospital (Backer, 2002). This is so because patients can fill the forms from the comfort of their homes.
Appointment confirmation: making calls to inquire whether patients will show up in the hospital is one of the best ways of reducing costs and other issues. Appoints confirmation should be done earlier to avoid cancellations and thus leading to revenue losses (Backer, 2002).
The back office
Chart preparation and referrals and ordering of tests are the origins of inefficiency in the back office.
Chart preparation: in many cases, there is no standard procedure for preparing charts for every patient encounter. Clinical subordinates may not be in a position to make them, but they should at least tell what is needed. In case results have not been brought, a medical assistant should be in a position to deliver test results efficiently (Backer, 2002). Besides, medical staffs need to check the charts for preventive services, screening or refills that might be necessary and then flag them so that the physician or the nurse can offer those services when a client makes a visit (Backer, 2002).
Referrals and tests: the medical practice additionally needs a standardized procedure of making referrals and carrying out tests. It should be clear who is responsible for completing paperwork when a test has been requested. Clarity must be made whether it is a clinician or physician. The staffs should be aware of the urgency of referrals and tests so that they can make prior arrangements with testing centres (Backer, 2002).
Doctors set the tone for medical practice. There are two ways in which these professionals can create efficiency, other there will be several problems.
Time to start work: starting work on time is one of the best ways of creating efficiency. If possible, a medic should be in the office 15 minutes earlier to handle some paperwork and prepare for the first appointment. Starting the work late can bring a lot of difficulties and clumsiness which can affect the efficiency of the entire day of work (Backer, 2002).
Standardization of processes: the issues arise here where physicians ignore following standard procedures and insist on working by personal perspectives. For instance, when an old doctor declines to use new technology, for example, EHR adopted by the hospital with the excuse that they are going to retire in a few days and chose to work using old methods. With HER there is a new flow of work in the entire process, and the old system becomes redundant. When the staff insists on employing both systems at the same time is preparation for a disaster (Backer, 2002).
Part 2: Contribution of the Affordable Care Act (ACA)
The following are the provisions of the ACA which are geared towards providing financial incentives in performance-based bonuses.
First, ACA champions for a delivery and payment system that enhance high-value care, better public health, better patient experiences, and reduced per capita expenditure on health. According to ACA, evaluation of the value of Medicare provided included reporting of results by results, experiences from patients, effectiveness and safety, population and cost of accessing medical services. These measures are examined through and collected through transparent, feasible, reliable and consistent manner (Berwick, Nolan & Whittington, 2008).
Secondly, the ACA advances delivery and payment reforms which include monetary prizes or penalties connected to performance. The reward structure is incorporated framework-based payment reforms designed to allow and enhance far-reaching behaviour change and achievement of performance objectives within the set time frame (Berwick, Nolan & Whittington, 2008).
Thirdly, the ACA advocates for programs which do not work in isolation but rather work in coordination with other related efforts to better evidence-based primary and specialty medical services. These programs should be incorporated into other creative and transformative initiatives that are geared to advance medical services across the health sector and stress on prevention and not reactive care, reduce the disparity of quality of medical services in various geographical locations and foster the physician-patient relationship (Berwick, Nolan & Whittington, 2008).
Fourthly, the contribution of transparency and oversight roles: doctors should be at the forefront in formulating methods used to develop and choose measures, gather data from physicians, and determine performance and report performance both to the public and hospital stakeholders (Berwick, Nolan & Whittington, 2008). Besides, the ACA advocates for open and transparent processes so that payers, consumers, and doctors understand that the expectations, results, rationale, are reliable and valid. Fifthly, the measures put in place by ACA must be focused on improving the welfare of the patients, are patient-centered and working in harmony with all other service providers in the health sector (Berwick, Nolan & Whittington, 2008).
Sixth, multilevel procedures which take advantage of modern technology and scientific evidence of measurement of quality with inclusivity and consensus among all stakeholders must be integrated, selected, validated, and refined for use among professional medical groups. The medical fraternity must have the knowledge of this whole process. The procedures adopted by ACA are field tested before implementation to ensure immediate success. The targets of ACA include better quality services, improved results, and reduced costs (Berwick, Nolan & Whittington, 2008).
According to the report by Groene et al., (2009), new strategies to improve performance and patient satisfaction include the following
Best buys for bettering patient experience
The best ways to better patient experience is the application of patient –centred consultations procedures and communication apprenticeship for health practitioners and feedback from customers. The evidence for these strategies is as follows: first, there is need to impact the patient’s knowledge. Educating health expert on how to communicate about the use of drugs will better the knowledge of patients. Secondly, change the experience of patients. Patient feedback platforms and feedback surveys need careful planning and implementation. Patient-centred communication approaches and adequate time for consultation in primary care raises customer satisfaction. Thirdly, the impact of costs and service use. Emphasis on public reporting of performance in the hospital setting can compel health experts to improve the quality of services. Finally, impact on health status and behaviour. Better communication skills by clinicians are poised to better health results (Groene et al., 2009).
ii. Communications training and consultation styles
This is another area of great concern in our hospital and which must be improved. The level of courtesy expressed by the emergency staff and the entire hospital team particularly to patients in pain is the key determinant of the patients rating on the quality of care provided. Studies in the United Kingdom and the United States reveal that the overall patient contentment is strongly associated with the interpersonal skills of clinicians (Groene et al., 2009).
iii. Provision for patient feedback reporting
The hospital has to create an efficient system of collecting patient’s feedback and complaints data to make their experiences better in all hospital departments. Besides, hospital workers can obtain real real-time information from patients by engaging them in discussions while serving them (Groene et al., 2009). This approach can provide valuable details if implemented and can transform service delivery once and for all.
iv. Patient and carer engagement in personal care
Our hospital looks forward to adopting strategies which will create carer interaction and family interactions which will make them more engaged to the patient-centred practices. The family members know the patient better, and their availability can help in reassuring and creating hope for patients in times of severe pain, vulnerability, anxiety, and uncertainty (Groene et al., 2009). Besides, the family members and relatives are best placed in giving detailed information on the history, routines, and symptoms which may prove significant in the treatment process. Such strategies include open visitation hours where the patient decides the best time to have visitors in the hospital. If this approach is adopted, it provides real experiences to the sick person and reduces anxiety by more than 65% (Groene et al., 2009).
v. Making information accessible to the patients and carers
Sharing medical record and intelligence is an excellent strategy of empowering patients and their families. Traditionally the hospital claimed the ownership of medical records, but our hospital will use the patient’s statistics to educate and to encourage carers and patients (Groene et al., 2009). The medical information like laboratory tests and progress statistics are brought to the ward and systematically explained to the patients. Also, future procedures can be anchored on the current medical report (Groene et al., 2009).
vi. Improved response to complaints
This objective is at the heart of the hospital reform agenda. The medical facility is determined to ensure improved listening and responding to the queries of our esteemed clients. The aim of this policy is to enable the hospital to learn, improve and respond to the experiences of the customers (Groene et al., 2009).
vii. New accountability policy
The hospital is determined to create opportunities for staff to be engaged in coming up with measures which will promote patient-centred healthcare. This will aid in easing the change of culture by teams as they feel part of the transformative agenda being made by the hospital management (Groene et al., 2009).
viii. Hospital employee satisfaction strategies
For our hospital to achieve meaningful quality improvement, the most valuable assets the employees must well take care of. The hospital intends to ensure that the labor force is treated with respect and dignity the way they are expected to treat patients and their families. Staff satisfaction research will aid to know where the hospital is keeping its employees contented and where it looks forward to being (Groene et al., 2009).
ix. Leadership and change management techniques
The traditional way of running operations in the hospital must be done away with. Culture change and leadership techniques to be utilized include staff and patient negotiating, chair-side or fireside chats, and employee, the board of management and clinicians interactions and unified efforts are some of the practical ways of strengthening patient-centred service delivery (Groene et al., 2009).
Backer, L. A. (2002). Strategies for better patient flow and cycle time. Family practice management, 9(6), 45-50 (Part 1)
Berwick, D. M., Nolan, T. W., & Whittington, J. (2008). The triple aim: care, health, and cost. Health affairs, 27(3), 759-769.
Groene, O., Lombarts, M. J. M. H., Klazinga, N., Alonso, J., Thompson, A., & Suñol, R. (2009). Is patient-centredness in European hospitals related to existing quality improvement strategies? Analysis of a cross-sectional survey (MARQuIS study). Quality and Safety in Health Care, 18(Suppl 1), i44-i50.(part 3)
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