The Patient Liberation Organization
Boulder Valley Women’s Health Center in Boulder, Colorado provides general gynecological and family planning services, teen health services, and abortion services. Prior to participating in a 2004 Patient Visit Redesign™ Collaborative, said Lynda Monsey, Nurse Practitioner and redesign team member, “We knew from the beginning, before Coleman Associates ever got involved, that our system was not optimal.”
“After we did patient visit trackings, we were ashamed and shocked to see how long we were taking to see patients and realized that we were forcing our patients to go through excruciating repetition in filling out forms—for no good reason,” said Susan Levy, Executive Director.
It’s important to the staff at BVWHC to have adequate time with patients. “They have many issues they want to discuss with us—and it’s not just about gynecology,” said Marni Siegal, Clinic Manager. “We spend time talking about issues that aren’t within our scope of practice to treat, and refer patients to other providers as necessary.” Sometimes, though, that “extra” time spent seemed to conflict with the clinic’s desire to increase access by increasing productivity.
Happily, with redesign, they cut family planning visits almost in half (to 35 minutes) and reduced longer appointments, such as annual exams and infection checks, by over a third, while still maintaining a very personal connection with patients. Productivity also improved, from 2.6 patients per provider per hour prior to redesign to 3.5 per hour after. “They were always sensitive to issues that women face in their lives,” said Pamela Weisse, their Coleman Associates redesign coach, “and very unwilling to compromise having enough time with each patient. But they’re also passionate in their desire to increase access to care, and determined to see patients in a timely way.”
One Year Later
One year after participating in Patient Visit Redesign™ training, Boulder Valley Women’s Health Center has maintained its good results, both in length of visit (cycle time) and productivity. They’ve already redesigned the teen clinic, and it’s showing stellar results, with cycle times averaging 34 minutes and productivity up from 3 patients per hour to 3.4.
Now they are using their internal skills and resources to spread redesign throughout the rest of the center. “We initially used the time with Coleman Associates to redesign family planning,” said Kelly Pollard, redesign team member. “We learned techniques we’ve applied in the rest of the clinic, and now we’re using them to change the way the abortion clinic is run.”
What about Confidentiality?
Confidentiality is a sensitive issue in women’s health clinics in general, but especially sensitive in abortion clinics.
Boulder Valley Women’s Health Center has been able to utilize redesign to enhance patient confidentiality.
BVWHC staff have realized that patients might feel exposed waiting in a public waiting room, so the Patient Visit Redesign™ principle “Don’t Move the Patient” has become a rallying point. Under the current system, as Kelly Pollard explains, “a patient signs in and is given paper work, is called back for labs, and then sits down in the waiting room. Next she is called back for an ultrasound, returns to the waiting room, is called up for payment, and then sits down in the waiting room again. Then she is called up counseling, after which she sits down in the waiting room. Then she is called up again for medication, returns to the waiting room, then finally is called back for her procedure.”
This whole process is being redesigned. By using walkie-talkies among staff members to communicate with each other the next steps in the process, patients will be seamlessly moved from one service to another without ever having to return to the waiting room. “We never say their whole name, but after saying ‘Mary’ ten times in the waiting room, everybody knows that Mary is that lady in the green sweater,” said Pollard. Pretty soon, once redesign is fully implemented, Mary will only have her name said once, when she is called back to an exam room. “As far as the patient is concerned these issues are real privacy concerns,” said Levy, and thus a very high priority for the clinic.
“I think that the reason why redesign works here is because every person who works at this clinic cares deeply about our ability to care for as many patients as we possibly can,” said Levy. Redesign is never easy—it disrupts old habits and patterns, and the transition to the new ways can be challenging. Most clinics, however, hold onto something that keeps them going when things seem bleak.
Redesign works here because every person who works at this clinic cares deeply about our ability to care for as many patients as we possibly can.
For Boulder Valley Women’s Health, “we could see the possibilities that were present with redesign,” said Levy. “It was the biggest operational shift that this organization has ever made.” They’ve seen the benefit in decreased cycle times, increased productivity, better access to health care and enhanced patient privacy.
Was it all worth it? Ask the women of Boulder. We’re betting they would answer that question with a resounding “yes!”
by Molly Weisse-Bernstein