Improving access to care: Orthopedics tackles visit length, booking and long waiters

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When you look at expected deliverables in health care it’s no surprise that access to care is high on everyone’s priority list. But, with more than 13,000 appointments to book within just one clinic in one year, and new monthly referrals topping 250, that ideal got the orthopedics team at the IWK thinking outside the box.

Serving a diverse patient population that includes patients with straightforward broken bones to highly complex surgical cases, orthopedics is one of the highest volume clinics at the IWK, making them a great team to pilot LEAN principles.

LEAN is a set of principles guiding organizational thinking based on continuous process improvement. Supported by the IWK’s industrial engineers, the orthopedics team spent days, weeks, months and piles of multi-coloured sticky notes looking at their processes from all sides to achieve their ultimate goal: improving patient experience and access to care.

Prior to starting LEAN, an average visit length for patients was 71 minutes. There were 625 new patients waiting for appointments and nearly 3,400 returning patients waiting. Two years into following this new approach though, those numbers have changed drastically.

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L-R: Dr. Ron El-Hawary, Karen Bartlett, Kristin Taylor

“We’ve improved access for everyone,” says Kristin Taylor, manager ambulatory surgical care in the children’s health program. “We cut our waitlist in half for new patients and also really improved access for the longest waiting patients.”

Average visit length has decreased to 60 minutes – freeing up 300 clinic days per year, – new patients waiting reduced by more than 50 per cent to 362 and the returning patient waiting list went down by more than 550 patients.

Clinical leader Karen Bartlett adds that she’s “most proud to eliminate our long waiter list from 300 to zero patients waiting over a year beyond their ready to be seen date.”

Numbers like those don’t just appear out of thin air. LEAN is a process and one that takes time. Dr. Ron El-Hawary, chief, orthopedics, was also heavily involved in this work. “It doesn’t just happen. You have to invest time, have the right people engaged. If you’re patient, you see results,” says El-Hawary.

In addition to patience, those results also took considerable effort and willingness to change. Orthopedics made big, and small, changes to their work and space that all added up to noticeable improvement. Some of those changes include:

  • a custom priority booking system algorithm (designed by Dr. Ben Orlik and industrial engineer Lucas Parafianowicz)
  • formatted standards of work and process – which have proven effective and sustainable even in a time of high turnover in the clinic
  • reworking inventory management
  • daily, morning huddles with the team
  • altering clinic appearance and design, and
  • committing to triaging new patients within 24 hours.
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In the end, Bartlett attributes their success to the commitment of the team. “We have to be pretty proud of our team. It was a lot of work from a lot of people that went into this whole process.”