Patients' use of care plans: A ten-minute engineering fix

Libby Hoy’s story:

I was brought in as the patient/family advisor for a Lean event, a one-week rapid cycle improvement event addressing the wait times in the outpatient clinic my kids were served in.  I was with the clinicians, nurses, administrators, the assistants who bring you back to the exam room, and the front office staff, so all three of the gears in our company’s emblem were represented on the team.  

We identified some of the deficiencies.  In the middle of the week, a conversation came up about a physician’s frustration with families not following their care plans.  The care plan had made sense, he said, but the family had not called back.  He proposed that the families didn’t really care about their kids.  

I spoke up and said, I’m very invested in this. Sometimes we don’t get the call back either. It’s very frustrating when you can’t get in touch with folks.  Others joined in.

The team realized that in the office’s phone tree, when patients called in, the call was routed to a voice mailbox of nurses and staff members who were no longer with the organization, so our messages were sitting in unchecked mailboxes.

There had been assumptions about miscommunication, with team members thinking that patient education might be needed to emphasize to families the importance of following the care plans.  Instead, there was a ten-minute engineering fix to route the phone calls to the right mailboxes.  That improved follow-up and the continuity of care, etc.  If all of us hadn’t been there, this would have gotten lost in translation.

This is an example of the value of co-design, and representing all the voices in the room, not just the patient’s perspective, but their interaction with clinicians and administrators.  That’s so important.  We’ve worked so hard over the last ten years to get the patient’s voice into the conversation.  The secret is in the interactions together to highlight the opportunities for co-design and improvement.  The pendulum is swinging, but in some ways having just the patient or family’s perspective is of as little use as just having the clinician’s viewpoint.  The interdisciplinary approach is better.

Libby is the founder and CEO of PFCCpartners, based in California.

Read a story of the co-production of medical care.