Community clinics are accustomed to working on a tight budget. Their patients are often among the poorest members of the community, with complex medical conditions that require ongoing care. It’s easy for these clinics to view themselves as “providers of last resort” and believe that working to improve the patient experience is the domain of health systems with more resources.
But leaders at eight safety net clinics in California understood that a more humanized experience would be needed for delivering on their mission to support patients, and essential to making their clinics successful in the shifting healthcare environment. They applied for and won a grant from the California HealthCare Foundation (CHCF) and formed the Patient Experience Action Community (PEAC), and were guided through a process of engaging front line staff to lead change by experts from the Experience Innovation Network, part of Vocera.
Program participants started their efforts by conducting a staff-wide pulse survey designed to quickly uncover physician and employees’ perception of the clinic as a place to work and come for care. In most cases, leaders quickly confirmed that before they could work on improving the patient experience, they had to address the burnout and challenges faced by their front line staff. Thus, the most successful organizations made addressing employee experience a top priority in their work.
Armed with insights from the pulse survey, as well as staff and patient focus groups, teams worked with frontline staff to design and implement solutions to close experience gaps for both employees and patients. Innovations included:
Boosting staff resiliency.
At Anderson Valley Community Health Center, PEAC leader Jessica McIninch, PsyD, led staff members on a 30-day mindfulness and gratitude pilot that resulted in an 89% increase in “gratitude” scores, 81% increase in “observe” mindfulness scores, 94% increase in “non-react” mindfulness scores, and 100% reduction in “burnout” scores among program participants.
Creating new patient support materials.
Lake Country Tribal Health created new patient materials that helped patients understand how to prepare for their visits, how to make the most of their visits while at the center, and how to organize and manage any follow up recommended by their clinician. In addition, they added an internal worksheet and revamped the checkout process to enable patients to immediately schedule follow-up appointments before leaving the clinic. These and other changes resulted in a 5% decrease in the volume of patient complaints, and the positive word of mouth created a 45% jump in the volume of new patients. In addition, staff’s net willingness to recommend the center as a place to work increased by 360% as a result of their engagement in the improvement efforts.
Introducing daily administrative staff huddles.
Share Our Selves (SOS) clinic adapted their existing clinical huddles for frontline staff, creating a daily administrative staff huddle. In the huddle, the staff reviews the day’s roster to identify service needs, such as insurance enrollment or patients visiting for the first time. This proactive approach allows staff to prepare paperwork and welcome packets (newly updated through the PEAC process) so they’re not scrambling when patients arrive. Improved workflow frees staff time for making appointment reminders and other care-related calls, resulting in a 20% decrease in no-shows. The overall work resulted in a 470% increase in staff willingness to recommend SOS as a place to work, and a 320% improvement in willingness to recommend the clinic as a place to come for care.
Streamlining the pharmacy process.
Neighborhood Healthcare’s clinic pharmacy at one location doesn’t accept all insurance – notably Medi-Cal. Physicians, unfamiliar with the details of their patients’ coverage, routinely sent all prescriptions to the onsite pharmacy. The team created lists of all accepted insurance carriers and posted them at medical workstations. In addition, they worked with medical assistants to create a process to verify patients’ coverage before sending a script. As a result, pharmacy errors and calls dropped from 10-12 per day to only one or none – and patients experienced less confusion and inconvenience.
Redesigning the after visit summary (AVS).
West County Health Centers needed to ensure patients received their AVS as they worked toward patient-centered medical home (PCMH) designation. The PEAC team worked with physician champions and patients to identify the most critical elements of the medical record to include in the AVS, and to build a workflow to ensure clinicians could complete all required documentation prior to concluding the patient visit. As a result, they boosted the proportion of patients receiving their AVS upon departure from 12% to 100%.
We are very proud of the efforts and results of all eight PEAC participants: Anderson Valley Health Center, Axis Community Health, Golden Valley Health Centers, Lake County Tribal Health Consortium, Neighborhood Healthcare, Santa Rosa Community Health Centers, Share Our Selves, and West County Health Centers. You can read more about each of their experiences and the lessons learned across their two-year journey of experience improvement in the CHCF PEAC report.