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Military-Style Workflow Boosts Cancer Clinic’s Patient Volume by 30%

Investigators identify six essential tasks

At the Johns Hopkins Kimmel Cancer Center clinic, a multidisciplinary approach to care combined with military-style efficiency has resulted in an increase in the daily patient volume and a decrease in emergency department (ED) visits. It has also freed up physicians to focus more directly on patient care, according to a report from HealthLeaders Media.

The Military Acuity Model (MAM) is a workflow that’s similar to the Lean management philosophy, but it doesn’t focus on physical resources in the same way.

“This method actually focuses on making sure the cognitive resources are in place for your staff,” researcher Shereef Elnahal, MD, said.

MAM aims to determine which tasks are most important to patient care, and which ones cost physicians and patients time and poorer health, respectively, if they’re not completed or if they are done incorrectly.

To make those determinations, MAM uses data mining. Elnahal and his colleagues mapped out every task required for care and then looked at a year’s worth of clinical data to see whether those tasks were completed. They correlated those tasks with clinical endpoints.

For instance, did patients call the clinic after their visit complaining of symptoms? Did they call because they didn't understand their treatment plan? Did they end up in the ED for an issue that could have been addressed during their clinic visit?

After examining the data, the researchers came up with six tasks that were the most critical for patients and workflow –– and they discovered something unexpected.

“All of those six high-value tasks could be completed safely by somebody other than the physician,” Elnahal said. “That left more time for the physicians and the front-line clinical support staff to do what they do best.”

At the Kimmel Cancer Center, the six tasks were:

  • Determining the patient’s assumed disease stage prior to clinic
  • Obtaining or performing necessary imaging studies
  • Determining which therapies, if any, the patient has received to date
  • Assessing the patient’s co-morbidities and offering treatment options
  • Assessing the patient’s social risk factors and offering treatment options
  • Assessing and treating the patient’s pain

Instead of being performed by physicians, those tasks were reallocated to two support staffers: a nurse and a unit coordinator whose main job, previously, consisted mostly of administrative work. Now, the unit coordinator has been “empowered and educated” so that she can organize and assemble information that clinicians need, according to researcher Joseph Herman, MD. She also proactively communicates with patients to tell them what to expect and answer their questions.

“Historically, hospital networks and systems underutilized their staff,” Herman remarked. But now, the unit coordinator’s role has evolved into something new.

The results of implementing the workflow have been striking. The clinic not only increased its daily patient volume by 31.4%, but in the 30 days after patients’ clinic visits, the percentage of patients who needed to call the clinic to discuss unresolved health issues decreased from 34% to 22%.

Further, the percentage of patients who had to go to the ED after a clinic visit decreased from 10% to 8%, according to the study, which was published in the March 2015 issue of the Physician Leadership Journal.

Making sure the six tasks were done and done well streamlined workflow and patient experience, and reassigning them to support staff allowed physicians to focus their energy on patient care, the researchers conclude.

They note that MAM can be applied anywhere. The only difference is that the “essential tasks” will vary depending on the facility and the care that’s provided.

Not only has the Kimmel Cancer Center clinic permanently incorporated MAM into its workflow, but Elnahal and Herman say they are working with Veteran Affairs and military health facilities, such as Wright-Patterson Air Force Base, that are interested in incorporating it, too. In fact, MAM was originally developed by the U.S. Air Force and an outside vendor. Now Elnahal and Herman have adapted the method for outpatient care.

“This method is not limited in any way to a particular setting,” Elnahal said. “I think there’s definitely huge potential for this to improve care outside of our particular scope.”

Source: HealthLeaders Media; April 14, 2015.

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