Oncology Rounds

Plan, do, check, act: Your four-step process to reducing patient wait times

by Ashley Riley

As we know, long patient wait times are a huge patient dissatisfier. We previously wrote about how one cancer program used RTLS to reduce patient wait times. But investing in RTLS isn’t financially feasible for everyone.

Today, we want to share how the University of Miami Health System’s Sylvester Comprehensive Cancer Center leveraged the plan-do-check-act (PDCA) method and Lean Methodology to reduce patient wait times by 22%.

Patients unhappy with long wait times

A few years ago, Sylvester Cancer Center found out that patients were dissatisfied with their wait times in the infusion center. On average, patients were waiting 77 minutes between their arrival and start of premedication during an infusion appointment. In response, the cancer program’s multidisciplinary performance improvement team conducted a Six Sigma analysis to identify the infusion center’s biggest opportunities. They used PDCA to reduce the number of patient touch points and streamline patient intake workflow.

Plan: Design a new workflow

During the plan phase of the cycle, the performance improvement team reviewed patient feedback, historic data, and infusion center intake workflows to map out each step in the patient pathway and identify non-value added steps. They developed a new workflow for treatment-ready patients that decreased the number of steps in the intake process from seven to five, and they reduced the number of staff involved with each patient from four to three. (Treatment-ready patients were defined as those whose labs were completed before treatment day and within normal limits and whose orders were signed the day before treatment.)

They prepared the infusion center staff to implement the new workflow by conducting one-on-one trainings that included a walkthrough of the new process and role play.

Do: Implement new workflow

To implement the new workflow, nurses identified treatment-ready patients by previewing infusion orders before each patient arrived. Patient care assistants were stationed in the predesignated area for treatment-ready patients and tasked with moving patients through the process steps. The performance improvement team collected and analyzed data each day.

Check: Review data and identify necessary workflow changes

At the end of the first week, the team reviewed the daily outcomes to identify barriers to the success of the new workflow and revised the process accordingly.

Act: Implement new workflow changes

In the final phase of the cycle, they implemented the changes and continued to collect data for five months. At the end of the study period, they observed a 22% decrease in the time from patient arrival to the start of premedication.

They also found that the new workflow allowed them to decrease time spent on non-value-added steps, such as sitting in the waiting area, during the intake process by 17 minutes. This led to a 28% increase in the proportion of total wait time spent on value-added steps, such as registering the patient and taking vitals.

If you’re looking to reduce patient wait times, you can replicate these efforts by evaluating your program’s biggest opportunities and initiating a PDCA cycle to capitalize on them.

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