Hi everyone,

Here it is September, and soon it will be fall. Children will return to school, and in certain parts of the country like the mountains above San Bernardino, the leaves will turn colors. It’s a beautiful time of year, all about change. Fall is the time to figure out how to be better at what we do in our personal and professional lives. And, given the theme of change – it is the perfect time to review some of the changes we’ve implemented at UCR Health and to share the work we’re doing. Let’s dive in.

First, our volume grew by over 8% last year. That’s excellent news. However, we also know we have a way to go in our service, quality, access, and patient follow-up. In past newsletter updates, I have written about the changes currently in progress. Following is an update on some continuing efforts and new improvement initiatives to improve service, quality, and patient access.

Clinical Process Redesign – Call Intake and Process Coordination

Patients communicate directly with our clinics through the MyChart message in-take process. This process offers patients direct access to our UCR Health Team of physicians, medical assistants (MAs), and authorization/schedulers. In our discovery, leadership has determined the initial system was set up without a care team approach resulting in a backlog of in-basket tasks including open billable encounters. That said, many of the in-basket tasks can actually be resolved by support staff. Our medical assistants are responsible for non-clinical/administrative tasks, which account for approximately 50% of their time, taking them away from patient care and negatively impacting the care team model. Furthermore, the lack of standardized work, processes, and metrics have resulted in patients leaving UCR Health due to gaps in communication.

To help everyone, and especially our patients, we have a initiated a redesign model and are glad to report we are improving our processes. We plan to revise the MyChart intake process to route support messages directly to the front and back-office staff, including referral questions. We will also create healthcare teams by pairing providers with dedicated MAs. Moreover, we will review and revise the staffing model to ensure adequate clinical and administrative support, including staffing support staff for residents.

After Hours On-call response

As you may know, UCR Health only has on-call for some services. Although we have systems in place to respond to patient needs, there needs to be more clarity regarding who should respond, within what timeframe, and whether this is a trackable metric for patient care follow-up. UCR Health uses an outside service to provide an initial response and screening which can result in a gap in documenting the dialogue between the provider and patient in Epic via a telephone encounter. In short, the answering service requires providing the information and verifying that the physician has contacted the patient.

We close the gaps in our on-call processing and notification system by reviewing the call data and understanding the existing process for contacting physicians. Our plan is to check the workflows from UCR Health Clinic Managers and Department Chairs on call handling and coverage and hold trainings to support documentation and billing procedures.

Rooming Encounter Process

Now for some very positive news. We’ve completed the design of a standardized rooming and encounter workflow through a collaborative process that included physicians and medical assistants. This workflow will improve the patient experience by reducing wait times and addressing quality metrics and care gaps during the visit. Existing, effective practices from other UCs were incorporated into our process redesign to ensure our success.

Over the next 60 days, we will be instituting re-training to standard work to guarantee a successful rollout of the new processes. We will also validate the rooming cycle and revise the MA schedules to create provider/MA teams and dedicated administrative time with benchmarks and validation processes. Additionally, we’ll start a 60-day sprint for the diabetic bundle quality metric with the Family and Internal Medicine departments to increase optimal diabetes care for our patients.

I realize that is a tremendous amount of information, but I hope it also gives you confidence that we recognize where we are not performing to the standards we expect and are humble in our approach to improvement. We cherish our patients' trust in UCR Health and will only stop once we continuously function at the highest levels for quality, access, and service. In future emails, I’ll continue to update you on our progress, summarizing our ongoing efforts in physician on-call notification, in-basket response, patient communication, and the MRI service expansion. To that end, I have asked each team leader responsible for the projects to provide a summary in their own words. Please let me know if you want to participate in these initiatives.

I hope you’re proud of your achievements and those of your team members. I know I am. The work is far from done, but there is excitement that we are creating patient care processes, access, and service that we trust. More importantly, that they trust. We are certainly on our way, thanks to all of you.

Enjoy your September.