Many clinics use a daily morning stand-up for the doctor and staff to review patients scheduled for the clinic that day, as well as to plan for their care. It has been shown to improve office efficiency and communication.

Despite these benefits, it has not become a universal practice. With the advent of new modes of care delivery and movement to accountable care models, this practice may need to be revisited. The “clinic efficiency” here is predicated on a health care model with value measured by the number of patients seen on site.

Waiting until the morning the appointments are scheduled misses the largest possible value in changing clinic processes. While it improves clinic operations, the daily stand-up does not put the primary focus on the patient, or the larger efficiency of clinical care. It’s tied to the business model, where access, payment, and processes are all connected to seeing a patent in clinic.

Focusing on office visits is no more productive than basing using how many pills were dispensed as a measure of pharmacy function, without assessing the 5 Rs of medication administration. The larger value to the specific visiting patient unable to get access is typically not calculated as a measure of efficiency optimization.

To facilitate clinical efficiency, there needs to be repeatable, executable and documented processes in place, and a clear definition of efficiency (outcome over cost) and the rubric used to calculate it.

In this manner, clinic operations can be made more efficient. Various modes and tools to deliver care and engage the patient as part of the team should be considered. With most patients accepting of all forms of virtual care, and being willing to provide data remotely, opportunities exist to direct clinical operations toward achieving the Triple Aim of health care. Patient needs can be served through SMS interaction, secure messages, phone calls, video visits, and in person visits optimized by prior planning.

In previous posts, we’ve discussed what it takes to improve care access and the importance of data interoperability. Greater clinical efficiency is also a critical consideration in the development of a new approach to clinical care and health support, aligned with the Triple Aim.

What are the key elements in improving operations and the patient experience?:

  • Plan for visits (in advance). Review patient-scheduled visits at least three days in advance if they can’t be reviewed at time of request. If in-person care is required, decide what action would make the visit most efficient (for example, labs in advance to visit). Advance planning determines not only whether an in-person visit is really required, but if it can minimize revisits or follow-ups.

  • Share the workload. The provider is not solely responsible for the patient encounter or its documentation. Documentation rules have changed. The focus should be shared through team efficiency, not just on provider efficiency. More staff can actually reduce efficiency by adding cost without improving outcomes.

  • Involve the patient. If the patient isn’t directly involved, how is it patient-centered care? The VA is using Veteran Online Scheduling and SMS self-care among other digital engagements to better involve veterans in steering their own care and scheduling. While there are some concerns, such as patients incorrectly booking an appointment, it underscores the need for the clinic team to effectively plan ahead. Educating veterans on these new tools also is important.

  • Standardize and refine the process. Apply standards and review lessons learned. That’s a key step. Change is inevitable, and should be thought of as an asset, not an obstacle. Be cautious with simply adopting a “best practice” without understanding all of the underlying assumptions, including financial drivers. Many commercial assumptions do not apply to federal healthcare, and will change as accountable care models grow.

The team huddle we discussed earlier is a good place to begin, and to revisit in the evolution of a practice model to focus on outcomes. A key part of the strategy is determining ahead of time whether the right encounter is taking place, or whether other health care tasks—such as pre-visit tests or labs—can be completed in advance. Whenever possible, engaging with a veteran without having a live appointment should be considered, if medically indicated and patient-approved.

In our next post, we’ll continue our assessment of the efficient clinical strategy. In the meantime, what’s your assessment of the current state of clinical efficiency and what needs to change? We’d welcome your feedback.

Ron Moody, MD

Chief Medical Officer – Accenture Federal Services

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