13/11/12

JANSON MEDICAL
CLINIC
A CASE STUDY IN QUALITY IMPROVEMENT
This case study analyzes administrative patient care processes at a
medical clinic. Customer survey results serve as the basis for the
analysis, they focus on three areas; making an appointment, care and
treatment, and checking in and out of the clinic. This study uses Six
Sigma tools to determine causes of patient dissatisfaction and the
factors that led to the dissatisfaction. The study concludes with quality
improvement suggestions and how these improvements tie back to the
initial survey areas.

Brian M. Riggle | Confidential

Brian M Riggle
11/13/2012

JANSON MEDICAL CLINIC

Doctors at Janson Medical Clinic also perform

surgeries at a nearby hospital. Often, these
surgeries are emergency in nature and take
longer than expected. Many of the doctors
also teach at this hospital. The clinic has three
departments with 20 or more doctors in each.
Unfortunately, there are only one or two
receptionists to answer calls for all three
departments. The receptionists job is to,
schedule appointments, provide directions,
and transfer calls to the proper secretaries,
which generally requires putting the patient
on hold (Evans & Lindsey, 2005, p682). If a
secretaries phone is busy, the receptionist
must hand-carry written messages to the
secretaries desk. Also, the receptionists
cannot leave their desk unless someone is
available to fill in while they are gone. (Evans
& Lindsey, 2005, p682)
The data for this study originates from a
customer survey of 100 patients using a 1-5
scale. Figure 1 shows a Pareto diagram for
the three main areas of dissatisfaction;
making an appointment, care and treatment,
and checking-in and checking-out of the clinic.
Further, it shows the sub-categories causing
the most customer dissatisfaction. The Pareto
diagrams indicate that the ease of getting a
convenient appointment, length of wait to see
a physician, and responsiveness to phone calls
relating to customer care are the three
leading causes of customer dissatisfaction.
Cause and effect diagrams (figure 2), enable
further exploration of potential sources of
customer frustration. Two common themes
exist amongst the three survey sub-areas.
The first theme is that emergency surgeries
sometimes take longer than expected to
perform (outlined in blue on diagrams). The
second theme is that one or two receptionists
are responsible for all three departments
(outlined in red in diagrams). An assumption
in this study is that no effort will be made to
expedite emergency surgeries. There are,
however,
opportunities
to
improve
receptionist work flow. It may serve the clinic
well to hire more receptionists, but for the
Brian M. Riggle

purposes of this case, process improvement

will be the focus.
Computer automation is the theme for
streamlining the processes of answering
phone calls and patient registration.
Reference text pages 683 & 684, figures 13.26
& 13.27, for the original processes. The
improved plan (figure 3 of this paper) creates
more time for receptionists to handle phone
calls by reducing the amount of time spent
registering patients. The refined patient
registration process integrates a computerbased, self-registration kiosk. The idea is that
patients, already established in the clinics
database, could simply log-in at a computer
kiosk located in the reception area.
Registration processing could, in many cases,
bypass the receptionists and go directly to the
nurse. Granted, self-registration could not be
used every time; some patients may be
computer averse or unable to use this system.
This refined patient registration flow makes
the assumption that a pre-defined number of
patients would be willing to register via a
computer. It also assumes that a study would
be conducted to determine how much time
the new process would save. Automation of
patient registration frees up receptionists
time to handle more phone calls. However,
the process used for answering phone calls
also requires improvement. The use of a
simple email system/sharepoint to send
messages to the secretaries rather than hand
carrying written messages should save
considerable time (figure 4).
How will revising these processes relieve the
sources of patient dissatisfaction? The major
change that improves a patients ability to get
a convenient appointment is automation.
Automation
allows
receptionists
and
secretaries more time to schedule
appointments, and prevents the possibility of
patients having their calls returned at a later
time, or not returned at all. The timeliness of
a patients request for an appointment is now
closer to the availability pool of doctors;
improving the patients chance of getting a
convenient appointment. The second issue,

JANSON MEDICAL CLINIC

decreasing the time a patient spends waiting
to see a physician, is address by automating
the patient registration process with a
computerized, self-registration kiosk. The
final concern is the responsiveness to phone

calls related to care. This is addressed by the

improvements made to the previous two
issues allowing receptionists and secretaries
more time to effectively handle phone calls
related to care.

Brian M. Riggle

JANSON MEDICAL CLINIC

Figure 1, Pareto Diagrams

Making An Appointment
14
12
10
8
6
4
2
0
Ease of getting a convenient

Ease of getting through on the phone

Convenience of the office hours

Friendliness of the telephone

appointment

receptionist

Check-In/Check-Out
14
12
10
8
6
4
2
0
Length of w ait to see a
physician

Courtesy and
helpf ulness of the
receptionist

Comf ort of registration

w aiting area

Mount of time to
register

Care and Tre atme nt

6
5
4
3
2
1

Brian M. Riggle

Respect shown
by
nurses/assistants

Confidence in the
physician's ability

Explanation of
medical condition
and treatment

Respect shown
by the physician

How well the

physician listened

Responsiveness
to phone calls
related to care

JANSON MEDICAL CLINIC

Figure 2, Cause and Effect

DiaDDiagrams

Doctors schedules
Doctors teach at local

Emergency surgeries
Take longer to perform

hospital

Ease of getting a
convenient appointment
Patients put on hold while messages
are hand-carried to secretary and
receptionists have to have someone
at the desk at all times

One or two
receptionists
for three departments

Receptionist issues

One or two receptionists

for three departments

Length of wait to see a

physician

Emergency surgeries take

longer to perform

One or two receptionists

for three departments

Receptionists responsible
for handling both inprocessing of patients and
answering phones

Patients placed on hold while

messages are hand-carried to
secretary

Receptionists have to
have someone at the
desk at all times

Responsiveness to phone calls

related to care

Emergency surgeries take

longer to perform

Doctors teach at local

hospital

Brian M. Riggle

JANSON MEDICAL CLINIC

Figure 4, Revised Process Flowchart for Patient Registration

1. At computer kiosk
- Patient signs in electronically
- Computer offers parking validation
- Computer finds proper encounter
form
- Patients insurance cards are scanned
into system
- Encounter form is electronically
routed to nurse
- Patient electronically signs encounter
form

- Computer asks patient to either

take
a seathandles
or see receptionist
Receptionist
copays and for
patients
who
are
unable
to utilize
copay
computer-based registration

Patient data is electronically

stored
Electronic encounter form is sent to
nurses station and nurse is
electronically paged

Patient is cared for and nurse

puts updated information in
patients chart

Receptionists have access ability to

input all data electronically to
eliminate paper copies.

Figure 5, Revised Process Flowchart for Answering Phone Calls

Call is received

Receptionist
answers call if
available

Answering
machine puts
patient on hold

Patient is
put on
hold

Message taken and

electronically sent to
secretary

Call is not returned

Brian M. Riggle

Call is
transferred
by
receptionist

Secretary
answers call

Secretary
returns call

JANSON MEDICAL CLINIC

REFERENCES:
Evans, J, & Lindsay, W (2005). The management and control of quality. Thompson, South-Western.

Brian M. Riggle