Flip No. 35

Meet a patient’s needs at the door

Inspired by a moment at the Apple Store, evaluate a patient when they first arrive to improve the patient experience

By Flip the Clinic

Developed at Flip the Clinic Lab: San Francisco

Within seconds of walking into an Apple Store, customers are greeted by a blue-shirted employee who shepherds them to whatever service or product they’re interested in. There’s very little upselling, few transactions require customers to stand in line, and the employees are reliably friendly and knowledgeable. As a consumer, all you have to do is show up and your needs are met.

There’s a reason Apple is known for its design. The Apple Store experience isn’t like other retail stores, and it’s certainly not like the average clinic. But Keith Seidel, the medical director at Southeast Health Center in the Bayview neighborhood of San Francisco wondered why not. Seidel started to investigate what changes would have to take place in order to make his center a more patient-friendly place from the moment someone opens the door. Just as it happens when you walk into an Apple Store with a phone that’s not working, Seidel says, “I’m trying to develop the clinic so that any time anyone walks in—even if they don’t know what their needs are—they get their needs met.”

Key Steps

  • Modify the appointment structure so it is 50 percent pre-planned, 50 percent day of.
  • Become proactive about public health, regularly generating personalized patient communications. Call patients for appointment reminders, health screenings, and immunizations.
  • Empower a “tactical” nurse to triage patients when they walk in the door.

Pilot

In a pilot that's been rolling out in stages since the Fall of 2014, Seidel started adjusting his clinic's infrastructure. A major problem was the waiting room; there were too many people in it—some 20-30 on average. Patients had to wait too long to get an appointment. And when they arrived, they had to sit in the waiting room for too long. When Seidel started at the clinic in 2013, the third next available appointment—an Institute for Healthcare Improvement quality measure—was 99 days out.

Seidel took a three-pronged approach to clearing the waiting room backup. First, he modified the appointment system so only 50 percent of available slots were open for patients to book ahead of time. The rest he kept open for same day and walk-in patients. Next, Seidel aggressively went after population size, “actively recalling people and managing care at a much higher level,” he says. Monthly, a staff member with an interest in public health would pull lists of people who were late on a required appointment and call them to come in. This strategy opened up the capacity for the clinic to take people who needed help immediately while also getting patients in need of regular check ups back into the clinic. Seidel recalls, “It was lovely when it rolled out, to see us moving away from productivity-based medicine to value-based medicine.”

Finally, Seidel installed his own version of an Apple Store greeter. When a patient walks into Southeast Health Center they’re welcomed by a “tactical” nurse who possesses a deep operational knowledge of the facility as well as a solid understanding of who a patient needs to see. If someone comes in to drop off paperwork, the nurse takes the papers right then and there. For immunizations, sore throats, or mental health issues, the nurse triages the patient on the spot, making sure they are ushered to the clinician who will best meet their needs.

Today, the health center’s third next available appointment is only five days out. There are typically around three people in the waiting room, and the time it takes patients to get from the door to the exam room is roughly four minutes. Southeast Health Center has embraced an Apple Store-esque design that truly honors the population it serves, respecting both their time and their health inside of the clinic and out.

Next up


Seidel wants to get patients into exam rooms even faster than his current four-minute average. One thing slowing down patients is the manual game of telephone that has to happen to alert greeters to clean exam rooms. Making the alert process electronic and immediate would shave off more of a patient’s waiting time. Seidel is hoping to partner with people who could help him with the technology to make it happen, which would in turn support one of San Francisco’s neediest populations.

Comments

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  • Rowdy Phillips-RN

    I believe this is an excellent idea. Patients are being triaged more efficiently and getting to a point of care much quicker. This kind of Flip definitely exceeds the aspect of patient-centered care. How nice would it be to walk into a healthcare facility and be greeted by a nurse who will guide and assist you to the area of care you need? I work in a rural community hospital that uses this kind of approach in the emergency department entrance area. The triage nurse is easily accessed upon entering the ED and quickly assesses the need for treatment. Once the type of care needed is obtained, the patient is taken directly to a room for the physician to examine. Since the initiation of this approach, emergency department wait times have been cut from forty-five minutes to twelve minutes. This not only helps create a better workflow, but patients are receiving quality care in a timely manner.

    • Whitney Bowman-Zatzkin

      Thanks for sharing this example!

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  • CKnoepke

    This is a really interesting and excellent idea – I hope it’s being scaled into other clinics as well!

    To bring the metaphor to the next level, might it be possible to expand the role of the “tactical” staff? I say staff because it might make sense to hire a crew of healthcare social workers who would not only carry the deep logistic understanding of the office and refer patients appropriately, but they could then shepherd patients (or even just certain groups of patients) all the way through their encounter. They could participate in mental health assessments, take notes and clarify treatment plans, and reduce time lost to patient confusion when moving to the next step (even if that next step is just to the front desk to schedule follow up visits).