By Michael Ronchka
Transformational change can seem daunting, but it doesn’t have to be. Ambitious goals are often reached by making incremental changes every day.
That’s the philosophy at the Toronto Rehab Outpatient MSK Clinic. A year ago some patients waited as long as 77 days from the time they were referred until their first appointment. Since then, the inter-professional care team set a goal of patients waiting no more than 30 days and they reached it. Now they’re aiming for 14 days.
Two members of the clinic team, Lisa Caldana, Service Coordinator, and Mariam Salama, Physiotherapist (PT), share five tips for making big changes with small steps:
- Set a stretch goal and when you reach it, set a new one
“We know if people receive treatment sooner they can recover more functionality in less time,” says Mariam. “That’s why we’re always striving to do better.”
The clinic team’s first Lean Rapid Improvement Event (RIE) in September last year was focused on reducing wait times to a maximum of 30 days.
Once the standard was set, the RIE team discovered barriers to clinic flow were limiting the number of patients that could be seen. Before the clinic team could start bringing patients in faster they had to think about making the discharge process more efficient. A lot of teamwork went into streamlining documentation, eliminating redundant forms, adding barcodes and replacing text fields with check boxes.
“After we reached 30 days, we set a new goal for patients to have their first appointment within 14 days of the referral,” says Mariam. “Aiming for 14 days was scary but it’s a goal and we’re working towards it, not reaching it doesn’t mean we’ve done a bad job. In fact, we’re seeing further improvement. Our data shows wait-time numbers are dropping significantly and some of our patients are now seen in less than 14 days.”
- Reflect on what you are doing and why
After the team held the RIE they were tracking the number of patient visits, but after a couple months they realized they were not taking action to move the metric.
“Don’t be afraid to question the way you work,” says Mariam. “Often we’re so busy we don’t take time to step back and ask why we’re doing what we’re doing. You have to periodically question what metrics you’re looking at, and if they’re not driving action, stop tracking them
- Understand what drives your performance
As part of the team’s visual management system they have a graph on the huddle board showing the time each patient waited for their first appointment, making it easy to see when the 30 day target is exceeded.
When patients were over the line the team recorded their condition to see if there was a pattern. They determined that most patients waiting longer than 30 days were trauma patients, inpatients and oncology patients waiting for both Occupational Therapy (OT) and PT.
“The data we collected indicated we needed to look at our scheduling process,” says Lisa. “We changed the way we schedule oncology patients because scheduling them for an OT and PT at the same time was increasing the wait times. Now we book them with an OT and ask a PT to join the case if necessary.”
- Verify the change had a positive impact
Even small changes sometimes encounter resistance. The long-term benefits from doing a little bit more work in the beginning to save time later on aren’t always obvious. Some changes really aren’t an improvement, but they stick unless there is a mechanism in place to evaluate them and roll them back if necessary. That’s where measurement can make the difference.
“It helps if we say we will try something and evaluate it,” says Lisa. “If the data shows it doesn’t work we’ll go back to what we were doing before.”
- Change your behavior to change your thinking
The most significant change, and often the most difficult one to make, is thinking differently. Seeing and solving problems is a skill that takes practice to develop, but it inevitably leads to a change in thinking. Every day becomes an opportunity to find a creative solution to a problem and to do something better than the day before.
“We never used to think about what we could do differently,” say Mariam. “Now we constantly think about what we can improve. That’s the real change.”
Healthcare is full of passionate people and when focused on a meaningful goal, even the toughest challenges can be overcome by teams solving one problem a day, making one improvement at a time.
Michael Ronchka is a Communications Associate – Lean Process Improvement at University Health Network.
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