With its relatively high volume of approximately 900 cases a month, Panama City Surgery Center (PCSC) in Panama City, Florida is an outpatient clinic whose 84 staff members feel the need to be maximally efficient, especially maximally time-efficient. In that regard, the surgery center’s leaders have, like virtually all of their peers across the U.S. healthcare system, struggled historically to manage patient flow and patient traffic throughput, in a way that improves the patient experience and clinician and practice productivity.
Leaders at PCSC turned to the Panama City-based technology vendor Jellyfish Health for support in their efforts, making use of its Jellyfish Access platform in order to replace the typically protracted wait in many high-volume facilities, with self-service check-in, shortened wait times, and real-time updates to family members on patient progress. As a result, PCSC has been able to reallocate the time of a full-time lobby receptionist to other needs, while reducing registration time by 68 percent. Positive feedback from patients and family members has been overwhelming, which portends well for the surgery center's patient satisfaction scores. In a related benefit, completed patient satisfaction surveys have increased by 28 percent now that patients can quickly fill them out from their mobile phone or computer as part of the Jellyfish solution.
Recently, Healthcare Informatics Editor-in-Chief Mark Hagland interviewed Mike Madewell, administrator of Panama City Surgery Center, regarding the organization’s initiative around improving patient flow, communication with patients and families, and efficiency improvement. Below are excerpts from that interview.
Your organization, Panama City Surgery Center, provides a broad range of surgical services, correct? Do you specialize in any particular areas?
Actually, we do everything but eyes. We don’t have ophthalmology, but urology, gynecology, orthopedics, gastroenterology, plastic surgery, general, surgery, pain management.
What was your baseline experience like, in terms of patient flow management and the clinician productivity related to patient flow? Why did you decide to engage a solutions provider?
As we got busier, we realized that we were having two problems. The first was at the registration desk itself. We operate with only two registrars; otherwise, we’d have someone busy in the mornings but without anything to do in the afternoons. But at peak patient traffic times, as we got so busy that that [having two registrars on duty] wasn’t enough, we had people waiting to get registered, or people waiting in the back. And we realized that pre-registering patients would help. There’s a software called OneMedicalPassport, which allows patients to complete a great deal of information via online pre-registration. With the help of that software, we call patients prior to surgery and ask them their medications and history, and that process is done by nurses. And that gives patients a log-in, and they can fill in their own information, so that nurses can review that information before calling the patient, so that speeds up that process.
And in our preoperative phone call process, the OneMedicalPassport solution helped streamline that process. It allowed us to not have to hire a third nurse to pursue that process. And we realized that we needed the same type of solution for front-desk registration, as it kept getting backed up. We needed patients to be able to check in without having to wait to check in. So if a patient were waiting to check in, they could check in with the Jellyfish process. So when I first started having this discussion with Jellyfish, and their design was designed for physician offices, I saw that it could work for us.
The other issue that we were having was a problem that Jellyfish could help resolve—once patients are checked in, and we have them checked in for surgery, and they have family members waiting in the lobby—and the biggest source of dissatisfaction is family members waiting for status updates. And there are all kinds of reasons why things don’t go as planned in surgery. And the challenge is communicating the updates, including delays, to family members in the lobby. And we used to have the kinds of pagers that restaurants have. But if they’re planning on waiting three hours, the range wasn’t broad enough; and there were privacy issues around phone calls. So we ended up having a full-time employee sitting in the lobby to manage that process, and that kind of helped, and patients appreciated that we were trying to communicate with family members.
And the thing is, moving forward, we will be paid partly based on patient satisfaction. It’s more than just making sure the surgery went well. And what we were finding is that most of the negative comments we were getting weren’t from patients, but from family members. And most of those comments related to wait times that were longer than expected, and they couldn’t get information; it was that whole information breakdown process.
And what we found out is that, when you’re asking the patient o fill out a survey, a lot of the comments were based on their families’ experiences. We were finding out that the patient would get home, and they would start talking with their families. And if the family member had had a bad experience—they hadn’t been communicated with, etc.—then the survey results would come out somewhat negative. So getting a solution was really important.
So what did you do, as you began this process of innovation?
We talked to Jellyfish, and they said, well, our program was designed for physician offices, but we think it would work perfectly for you. So we looked at what they had, and modified it for our processes, and went live in February, and we added a second terminal. We have operating rooms and preop areas that a physician office doesn’t have. But a patient comes in, they get a unique identification number, and put their cell phone number into the system. So now we can send them a text. And if it’s going to be a long surgery, the family member can go shopping and come back. Or if we need to communicate anything else to them. And the screen in the lobby shows all the different areas in the surgery center. It’s like when you’re on an airline flight and the screen shows you where your plane is. So I can look and see where my family member is, by a number that identifies them. So I know where they are. And if there’s an update or delay, the program will say, “Patient 48 is in the operating room,” and when Patient 48 goes to recovery, that number pops up on the screen, from Recovery. And a little message will pop up saying that Patient 48—the family member can go talk to the doctor. So you’re not having to track people down.
And because of that, I’ve eliminated that full-time position of that person who sits out in the lobby. And the patients like it, because it’s real-time information, they don’t have to ask what’s going on anymore. Family members, from day one, have said, this is really awesome. I feel more comfortable now because I know where my family member is.
The thing is, we can have 40 people in the lobby at any given time. Having to have someone run back and forth is too difficult. My staff loves it because it’s easier. And I love it because I was able to repurpose that staff member. And the patients and family members love it.
And there are a number of dimensions to all this, correct?
Yes; there are other parts to the software that we’re rolling out soon. There’s a physician communication piece that’s next. If a physician has an app on his phone and start-time for a particular time—the system has an algorithm that can see that a room is delayed for an hour, and it notifies Dr. Jones. It automates that process, too, something that we were having to manually do.
So there’s a lot of time savings, and that translates into FTE savings. But the biggest thing for me is that patient satisfaction. We finally have a tool to use that really resolves that issue about communicating with family members in the lobby. All the other solutions we had tried were very labor-intensive, and didn’t really solve the problem. That’s the biggest thing that we like about it. And quite honestly, there are clinical studies out there that show that patients who are happy, heal faster. That mental state that they’re in has an effect on the healing process. On the other hand, if they go home stressed and their family members are stressed, they won’t heal as fast. So it’s not just about positive ratings, it’s about a healing experience.
What advice might you have for CIOs and other healthcare IT leaders, based on your experiences here?
I would share with them the same advice that I’d give around implementing any new software. There is a period of learning that will take place, and there’s a learning curve, and there’s a period of adjustment. And that learning curve isn’t very big with Jellyfish. But once you’ve gone through that, there’s no way you won’t be happy with the results.
We all have to use software to run parts of our businesses and lives, and the most frustrating thing is that when software is working fine, we’re happy with it, but when there’s a problem, how quickly does the vendor respond? Jellyfish has always been great and very immediate. We’re getting ready to change our base software that we run our surgery center off of, and when I went to Jellyfish and told them we needed an interface, and their response was, no problem, we’ll interface with anybody. And you’re always going to have hiccups and glitches, but their response was great.