The No-Show Patrol Aims to Decrease the No-Show Rate and Improve Performance in Public Health

Summary

Impact Statement:

A knowledgeable and involved team, subject matter expertise, and the Kaizen improvement method helped the Madison County Health Department reduce their client no show rates in the Family Planning Clinic. Root cause analysis led the team to create standardized process procedures, client scheduling and follow up protocols, and internal and external communications. Improvements achieved include: • Reduction in no show rates - 10% • Reduction in wait time for appointments by - 2-4 weeks • Increased staff efficiency + 4.2 hours / week • Increased client satisfaction • Improved clinic and staff teamwork and communication.

Summary:

We at MCHD aim to reduce the No Show Rate in our Family Planning Clinic from 35%-25%. This is important because we want to maximize available clinic time. We will accomplish this by establishing standardized procedures, patient follow up protocols, and communication methods for all stakeholders.

Organization that conducted the QI initiative:

Madison County Health Department (MCHD)

Citation:

Wallin, R. Public Health Quality Improvement Exchange. The No-Show Patrol Aims to Decrease the No-Show Rate and Improve Performance in Public Health. Wed, 07/29/2015 - 11:06. Available at http://phqix.org/content/no-show-patrol-aims-decrease-no-show-rate-and-improve-performance-public-health. Accessed April 19, 2024.

Background and Aim

Aim statement:

The staff of MCHD aim to reduce the no-show rate in the family planning clinic from 35% to 25%. Reducing the no-show rate is important because the staff want to maximize available clinic time. MCHD will accomplish this goal by establishing standardized procedures, patient follow-up protocols, and communication methods for all stakeholders. MCHD also hopes to • decrease wait time for appointments from 4–6 weeks to 2 weeks by double booking appointments, • see further decrease in wait time because of the increase in providers, • increase efficient use of staff time and resources, • increase time use from 40.8 hours per week to 45 hours per week, • increase client responses to surveys with specific questions, and • adapt as needed based on client responses.

Need For The QI Initiative:

Before quality improvement (QI) 101 Wave 7, the team lead picked the staff members' brains to ask for suggestions for a QI project. Three ideas were given to the team lead. One was budgeting in environmental health to reduce the cost of the initial permit fee, one involved clinic flow, and the third involved addressing no-show rates (a general problem for all clinics). MCHD chose to target the no-show rate because the clinic was being reconstructed during the action period. To scale the project down, MCHD chose to focus on its biggest program outside of immunizations.

Area for Improvement:

The no-show rate in MCHD's family planning clinic was 35%. MCHD had the opportunity to improve on the wait times until the next available appointment because two new family nurse practitioners (FNPs) were hired; in the past, there had been only one FNP. To ensure that provider time was used to see patients, MCHD staff believed that they needed to address the no-show rate.

Root Cause:

Root causes identified in planning the initiative were as follows: • There is no way to communicate with patients about appointments (cannot reach patients with a reminder call). • Patients do not have transportation to their appointments. • Inclement weather is an issue.

Planning and Execution Details

QI Implementation:

The QI team initially took this project on. During the Kaizen event, several things arose that the team did not think about before the event. The billing/administrative staff member pulled a list of missed appointments and made an alert flag in the electronic medical record (EMR) to identify chronic no-show patients. The front desk staff were brought in to discuss changes with scripting for reminder calls and follow-up calls for patients who miss appointments. The QI team hoped to eliminate barriers to patients coming to their appointments and to identify trends. The dental center manager, environmental health specialist, and a front desk staff member completed a Gemba walk. From this, they created a training manual for administrative staff to use when registering patients. Standard work became a huge focus for MCHD during the initiative. The team lead created a survey for staff and customers related to reasons for patients missing appointments. During lunch on a day of the Kaizen event, nurses were brought in (including the family planning program coordinator), and their input was obtained. The FNPs were also consulted for feedback. The QI team decided to double-book on 2 days a week in the mornings to accommodate missed appointments. The billing administrative staff member edited the schedule template to allow this. This QI initiative involved six team members, the health director, the DON, and the administrative officer. All staff members were also informed of this initiative via a staff lunch. Three nurses, two FNPs, and two additional administrative staff members were involved with input about changes. FP clients were also surveyed via paper and telephone. Information about this project was also presented to the Board of Health.

Focus activities

Administration:

Customer Service/satisfaction

Policies / internal procedures and processes

Quality Improvement and Accreditation Readiness

QI Methods:

Lean/Six Sigma

Model for Improvement

Rapid Cycle Improvement

QI Tools:

Fishbone Diagram

Surveys

Other QI tools:

Standard work

8 wastes worksheet

Plan, Do, Study, Act (PDSA) worksheet

Value-stream map

QI Tool Documentation:

waiting_list.pdf

pdsa1.pdf

pdsa_survey_1_21_14.pdf

pdsa_cycle_template.pdf

pdsa_1_21_14.pdf

no_show_follow_up_script.pdf

no_show_call_log.pdf

information_needed_for_initial_visit.pdf

copy_of_madison_county_data Reasons for NS (Client).pdf

copy_of_madison_county_data No Show by type.pdf

copy_of_madison_county_data Employee Survey Results.pdf

copy_of_madison_county_data Cost Analysis No Show.pdf

copy_of_madison_county_data Client Survey Results.pdf

copy_of_madison_county_data Client Demographics.pdf

copy_of_madison_county_data Ages.pdf

communication_plan_pdsa.pdf

charter_mchd.pdf

Initiative Dates:

11/7/13 to 4/1/14

Initiative Duration:

Less than 6 months

Methods of evaluation:

As part of the Center for Public Health Quality (CPHQ) QI 101 program, MCHD created a detailed measurement plan consisting of a balanced set of process, outcome, and balancing measures that were tracked throughout the project. These data were displayed in run charts to assess progress toward the measurable goals outlined in the aim statement. In addition, MCHD collected qualitative and quantitative data demonstrating the need for the project at the beginning and before-and-after data specifically related to the PDSA cycles throughout the project.

Other Information:

Other results of the QI project included the following: work was standardized; scripts for “common language” for reminder calls were used; a registration manual with images for a streamlined process was developed, and all administrative staff will be trained to address staff concerns; a call log and waiting list with clear directions were developed; a resource guide for the social and physical needs of clients was used; office staff (registration and clinic staff) will receive a notification of “no-show” patients; and log sheets are available to record and analyze potential trends (e.g., weather delays, holidays).

Supplemental Materials:

Testimonials

Sample of materials produced

Storyboard

Supplemental Files:

Attachment	Size
wksp2pptfinalmchd.pdf	10.57 MB

Results

Training and Preparation

Information about the Community

Population Size:

Less than 24,499

Population Characteristics:

Madison County offers 288,800 scenic acres (452 square miles) of beautiful mountains and fertile valleys. With whitewater rafting, snow skiing, the Appalachian Trail, scenic byways, and a hot natural mineral spring, Madison County is rich in outdoor recreational opportunities. Nearly 73% of the county is forest land, and nearly 25% of the county acreage is managed by the U.S. Forest Service. Madison, ranking 53 in size among North Carolina’s 100 counties, is located 15 miles north of Asheville on the North Carolina/Tennessee border. Three municipalities are located in the county: • Mars Hill, population 1,798 • Marshall, the county seat, population 828 • Hot Springs, population 635 In Madison County, 17.7% of the population is in the 65-or-older age group, compared with 19.0% region-wide and 12.9% statewide. The median age in Madison County is 49.5, whereas the regional median age is 44.7 years and the state median age is 37.4 years. In Madison County, the population is 96.5% white/Caucasian and 3.5% nonwhite. As calculated from the most recent estimate (2006–10), the median household income in Madison County was $38,580 compared with a mean Western North Carolina median household income of $37,815, a difference of $765 more in Madison County. The median household income in Madison County was more than $6,900 lower than the comparable state average for the periods cited in Table 13 (see QI Tools), but the gap narrowed by $579 from 2005–09 to 2006–10. As calculated from the most recent estimate (2006–10), the median family income in Madison County was $49,838, compared with a mean Western North Carolina median family income of $47,608, a difference of $2,230 more in Madison County. The median family income in Madison County was more than $6,300 lower than the comparable state average for both periods. The 100%-level poverty rate in Madison County was 16.9% in 2005–09 and 2006–10. In both periods, the poverty rate in Madison County was higher than the comparable rates in both Western North Carolina and North Carolina as a whole.

The No-Show Patrol Aims to Decrease the No-Show Rate and Improve Performance in Public Health

Summary

Background and Aim

Planning and Execution Details

Results

Training and Preparation

Information about the Community

Information about the Health Department

QI Staff Information

Accreditation Details

Collaborations

Contact Information of the Submitter

QI Spotlight

quality improvement together.

Search form

You are here

The No-Show Patrol Aims to Decrease the No-Show Rate and Improve Performance in Public Health

Summary

Background and Aim

Planning and Execution Details

Results

Training and Preparation

Information about the Community

Information about the Health Department

QI Staff Information

Accreditation Details

Collaborations

Contact Information of the Submitter

QI Spotlight