Northeast Clinic Turns Flood Disaster into Workflow Improvement Opportunity

On Sunday, January 18, 2009, Jo Ann Wagner Novak, MS, RNC, a nurse practitioner at the Northeast Family Medical Center, stopped by the clinic to quickly check her e-mail.

But when she opened the front door, she found water, water, everywhere—cascading like a waterfall down the stairs to the lower level.

A pipe burst had completely flooded the front end of the clinic. Standing water was everywhere. Offices were waterlogged. And the reception desk and waiting area were destroyed.

That was January. Now, after nine months of cleanup and rebuilding, the clinic is back to normal with new carpeting and furniture. In fact, it's better. This disaster ended up being the perfect opportunity to make long-term workflow improvements that will benefit staff and patients alike.

Northeast Clinic, Before & After the Flood

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Coming Together in a Crisis

Clinic Manager Deb Sanftleben first got news of the flood from her facilities manager, who had been notified right away by Joanne Novak. "His words were, and I quote, 'Boss, this is bad,'" she laughed.

Fortunately the next day was a holiday, and the clinic was only open a half day. Sanftleben had a triage nurse cancel those few appointments, and then she and her crew spent the rest of Sunday and Monday rearranging the dry areas of the clinic so patients could come in Tuesday morning.

"We made signs directing patients to come in through the back door," she said. "We opened up like normal on Tuesday, but it was noisy. Workers were everywhere, fans were blowing, and patients were waiting on chairs up and down the hallway by the nurses' station."

But Sanftleben is proud of how everyone worked together to get the clinic back in business so quickly. "They went above and beyond the call of duty so we could get back to taking care of our patients," she said.

Physical and Operational Fixes

The area that suffered the most physical damage from the flood—and also needed the most long-term workflow improvement—was the front desk. Not only did the previous front desk area lack privacy, it also wasn't set up operationally to allow patients to schedule multiple types of appointments at once.

For example, a patient who needed appointments for a follow-up, a referral, and an x-ray would have had to visit three different schedulers throughout the clinic.

But now, the rebuilt front desk has more seats for patients, with a wall between each seat to ensure privacy. And reception staff have been cross-trained to schedule many different types of appointments—all from one location.

The clinic made other improvements as a result of the flood. Another blood drawing station was added in the laboratory before the damaged floor got replaced. The pharmacy reception desk was rebuilt with higher, more private counters and a stronger door for the pharmacist's safety.

And wisely, every piece of new furniture ordered is modular, so the clinic can reconfigure in the future without having to tear everything out and start over.

Working Toward Lasting Improvement

According to Louis Sanner, MD, MSPH, the Department of Family Medicine associate professor who spearheaded the workflow improvements, these changes dovetailed nicely with the clinic's implementation of the Epic electronic medical record system.

"We were already thinking about how we do workflow at the clinic," he said. "With computer-based order entry, we have capabilities that our old, paper-based workflow wouldn't have allowed for."

That's why Dr. Sanner is also leading a group-based quality improvement (QI) initiative at the clinic. In the past, QI was the responsibility of a small committee, but now, all clinical staff meet every other month to tackle ongoing quality projects.

Not that Dr. Sanner recommends other clinics launch QI initiatives the same way. "Yes, periodically, you should flood your building," he laughed. "But really, part of how you redesign work is getting people involved in figuring out how best to do things."