Eau Claire Resident-Led Microsystems Project Leads To Efficiencies, Better Care

Department of Family Medicine (DFM) Eau Claire resident Krissa Schuldt, DO, is the first resident in the UW Health system to lead a Microsystems performance improvement initiative.

Since last fall, her team has implemented several changes at the Eau Claire Family Medicine clinic that have resulted in more efficient clinic flow and potentially better care.

Why a Resident-Led Team?

In the fall of 2010, the Eau Claire clinic joined the second wave of UW Health clinics participating in the Microsystems initiative, a system-wide effort that aims to improve small, specific areas of clinical practice.

From the outset, Mona Mathews, MS, the clinic’s designated Microsystems coach, and clinic faculty expressed interest in creating a resident-led team. They thought that leading a Microsystems project could provide residents with outstanding training in practice redesign, interdisciplinary team building, and overall leadership.

Upon being nominated, “I jumped at the chance,” said Dr. Schuldt. “These skills are good to learn. We need to be able to implement effective healthcare that cuts costs while maintaining excellent patient care and satisfaction.”

The interdisciplinary team—which consisted of Dr. Schuldt, Mona Mathews, x-ray and laboratory technicians, clinic management, nurses, and a medical assistant—first attended several learning sessions on designing and implementing a Microsystems project.

The Importance of Previsit Planning

The team decided to focus on improving patient and staff satisfaction, while maintaining excellent patient care. One way to accomplish this is to decrease cycle time: the total amount of time from when a patient checks in at the clinic until he or she checks out.

“Patients want their time to be spent with a doctor, not waiting in the exam room,” Dr. Schuldt said.

The team began with previsit planning. For example, patients with chronic diseases might need to fast or visit the lab before their visit, or exam rooms might need to be stocked or set up a certain way.

Previsit planning can result in more efficient patient flow and better care, Dr. Schuldt explained. “If I can schedule a patient’s labs before their appointment, often the results are ready before I see them. Then I can give them their results right there during the visit, deal with any issues then, and not have to do a follow-up phone call.”

Cycle Times Down, New Improvements Underway

Results so far have been positive. Over the past several months, cycle times for Dr. Schuldt’s patients have decreased: the average total time between patient check-in and check-out is about 1.7 times the scheduled appointment duration. It had been at about 2.0 before the Microsystems project began; 1.5 is the goal, based on national guidelines.

Previsit planning has also begun to spread throughout the clinic. Although it’s too soon for results, patients and physicians have already commented to Dr. Schuldt that the clinic operates a lot more smoothly now.

Communication is a key component of the initiative. Dr. Schuldt’s team holds regular huddles to make sure everyone is on the same page. The entire clinic also participated in a learning session about using the huddle tool to communicate the visit plan, and huddles have since been implemented clinic-wide.

Now, the team is tackling new projects aimed at improving rooming time, keeping schedules accurate, and redesigning OB and pregnancy test visits to be more efficient. They’re also engaging patients through surveys and focus groups.

As for Dr. Schuldt, the project has been an outstanding learning experience. “I’ve grown as a physician and a leader throughout the project,” she said. “I feel more confident in creating effective, positive interdisciplinary teams to work through continued health care reform and practice redesign—as I complete residency and beyond.”