Myth Busting: How Will DPI™ Impact My Day as a Provider?
Have you recently discovered that Dramatic Performance Improvement™, or DPI™, is coming soon to an exam room near you? Upon hearing that “workflow efficiency experts” are coming to work with your staff and clinic, you likely wondered whether these so-called experts will actually help you, as a provider, and wondered whether the upcoming changes will add to your already lengthy daily to-do list. As is true prior to implementing any new system, it’s normal to feel some concern about the changes, especially when considering everything you must currently do in order to complete your work and leave the office on time: seeing 20+ patients each day, documenting visit notes, entering billing details, reviewing lab results, listening and responding to phone messages, viewing portal requests, refilling prescriptions reading outside specialist notes and reports, contemplating diagnoses of complex and chronic conditions, delivering sensitive news, and helping to lead your team. Perhaps, as well, you’ve already learned how to survive within your practice’s current (though possibly broken) system, and—on top of that—the words “efficiency improvements” sound awfully alike “more patients” and “more work”.
This article is designed to address four myths associated with DPI™, clarify the intention of the program, and—hopefully—put your mind at ease as your practice embraces change.
#1: DPI™ will increase the number of patients providers must see
Efficiency: this word is not synonymous with seeing more patients or completing more visits than are currently expected of you. However, it may very well mean you will begin to see the number of patients your schedule is built to see. DPI™ works to improve scheduling practices and reduce No-Show rates. We’ve seen the following results from a decrease in the No-Show rate: more patients complete their scheduled appointments, and/or Robust Confirmation Calls give your team lead time when a patient cancels, thus leaving more time to fill canceled slots with different patients. These steps can improve access for patients, which in turn builds more predictability into your schedule. While efficiency may increase the number of patients who complete appointments, it doesn’t equal pressure to complete additional visits, nor does it equal an increase in your expected daily patient load.
Sometimes we encounter health centers who, prior to DPI™, have inflated their schedule templates to compensate for a high No-Show rate. For example, a patient schedule includes four patient slots per hour, but clinicians are only expected to see three patients per hour. If this is the case for you, don’t panic. We understand that providers can only reasonably see so many patients within a given day. We have often advised health centers to adjust schedule templates after a certain number of clinic sessions where data proves that No-Show rates are optimal. These adjustments help ensure that patients receive quality care, and that your team feels confident about providing this care. This is one reason we work with a Pilot DPI™ Team first! Your DPI™ Team is comprised of a provider and staff members serving as “guinea pigs” to test and prove consistent success of protocols before a new, clinic-wide schedule is considered. Based on our experience, we predict that your center’s current, inflated schedule template will already be deflated by the time your No-Show rate reduces!
#2: DPI™ will change our current workflows
DPI™ will likely change your current workflows. DPI™ may suggest a new place for you or your medical assistant (MA) or nurse to sit—in order to work together—which could affect the order in which tasks are completed. QuickStart, for example, requires that Provider and MA start the first visit of the session together, in the exam room. While this adjustment impacts everyone, studies show this method to be a best practice in reducing wait times, improving efficiency, and preventing tardiness.
Our recommendations are based upon your current processes, stated goals, resources, and ancillary services. For this reason, we cannot predict exactly which tactics and tricks will work best for your individual clinic. We assure you, however, that your practice will, at minimum, see workflow changes that impact communication between providers and your MAs or nurses, as well as changes to your team’s patient preparation process.
For example, your habit may be to look ahead at tomorrow’s patients while reviewing recent visit notes on these patients. DPI™ typically suggests that your MA or support staff look ahead, instead, so that they can learn how to make visit notes using a Visit Prep tool—while saving you time. The Visit Prep tool was created by MAs and providers and serves as a starting place for your MA to determine how best to complete patient preparatory work, and to report their discoveries from the morning’s Patient Care Team huddle. A report like this may read as follows:
Roland is an 82-year-old male. He has a history of dementia and has been prescribed Xanax at night. He is coming in for his annual wellness visit. His daughter, who is his caregiver, said he did not yet get the flu shot and they asked about the Pneumo vaccine as part of his visit tomorrow. I also checked and he is due for his Tdap and shingles zoster as well. They said he used up all his steroid medication and they will bring in a list of everything he is taking.
The purpose of this report is to save you time by providing you direction for the visit. Decisions such as whether to provide the vaccine or refill the patient’s prescription are, of course, still yours to make. In response, you may send a report or relay a verbal response in the huddle to your MA. It would read as follows:
I remember Roland. Last time his Xanax ran out faster because his new caregiver was giving daily rather than PRN, let me check with his daughter about whether he’s still taking it consistently to decide how to prescribe. As for the vaccines, let’s do flu and Tdap and the zoster today. I’ll give you the notice to get those drawn up at the Midway Knock.
This new Visit Preparation workflow relies on your MA to stage the visit, and thereby saves you time in the long-run by teaching your MA how you like your visits set up and how you typically interact with your patients. In addition to saving you time each day, delegation of such prep work can prevent provider burnout.
#3: The Midway Knock is intrusive
Before implementing Coleman improvements, we often observe providers coming out of exam rooms searching for their MAs. Sometimes it is because the provider needs labs drawn, or a vaccine given, but at other—less fortunate–times it is to request a missing instrument, such as a speculum or an oversized BP cuff. The Midway Knock helps prevent embarrassing occurrences like these, which can damage a provider’s image in terms of bedside manner. The Midway Knock comes at roughly the halfway point in the visit and provides a timely check-in to ensure that both provider and patient have everything required to successfully complete their visit. Per protocol, the MA knocks briefly, waits for an ‘ok’, and then enters the exam room to receive instruction on what the patient and provider need before stepping back out.
As long as the MA listens at the door for a pause in conversation and/or any cues not to interrupt, then the knock should be helpful, vs. intrusive. If we use Roland, the patient mentioned above, as an example, his Midway Knock allows his MA to draw vaccines up part-way through the provider portion of the visit, thus shortening the time Roland must wait in the exam room after his provider has exited. Roland can receive his vaccines directly after he’s completed the provider portion of his visit, reducing Cycle Time. This practice also demonstrates “Effective Patient Care Team Communication”, which is an area of evaluation on many patient satisfaction surveys, including the Press-Ganey sample below.
#4: DPI™ will contribute to provider burnout
Fewer and fewer medical students are choosing to enter into practice as primary care providers. One article, entitled In Search of Joy in Practice, citing research on 23, high-performing primary care practices states, “although waning interest in adult primary care careers is multifactorial, driven by such forces as the primary care – subspecialty income gap, medical schools’ devaluing of primary care and the unsustainable primary care work life issue — one study suggests that the difficult work life may be the most influential factor discouraging medical students from primary care careers[i].”
DPI™ works to improve professional life and provide what is missing in a physician’s day. Of DPI™’s impact on her team, one provider said:
This process helps with burnout. It can’t get any worse than it was before. The communication, the sharing responsibilities amongst the team instead of the provider being in charge of every little detail, is amazing. We see more patients than before. We used to leave at 6:30- 7. Now we see more patients and leave on time. – Cyndi Countryman, NP.
Below are four main areas in which DPI™ can improve professional life and thus reduce provider burnout.
- Sharing the care: building up the working roles of the entire Patient Care Team, with the MA as Shepherd.
- MAs managing workflow
- Completing work of charting in real time
- Reduction of medical errors
- MAs conducting Pre-Visit Planning activities
- Patient Care Team Huddles
- Focusing on goals associated with quality care
- DPI™ highlights non-anonymous collegial display of data and recognition of operational and quality outcomes excellence. You will never be more focused on data than you are during DPI™!
- Team communication
- 30-Second Reports between Provider & MA
- Midway Knocks, as described earlier in this article
- Red-Carpet Exits to ensure patients leave with all their needs met (also reducing the need for call backs or emails)
In Conclusion: We hope that this article has addressed the myths that DPI™ increases your patient load, that the Midway Knock is intrusive to patients, and that DPI™ will increase provider burnout. We also hope we’ve emphasized that DPI™ will change your working habits and workflows—for the better. As Tony Robbins states, “Change happens when the pain of staying the same is greater than the pain of change.” If burnout is getting you down, article two in this series will address how new DPI™ workflows can cut through the pain of change.
[i] Sinksy, Christine, MD. Willard-Grace, Rachel, MPH. Schutzbank, Andrew, MD. “In Search of Joy in Practice: A Report of 23 High Functioning Primary Care Practices.” Annals of Family Medicine. www.annfammed.org Vol 11, No. 3, May/June, 2013.