9/14/2015

InstituteforHealthcareImprovement:FailureModesandEffectsAnalysisToolProcessDataReport

FailureModesandEffectsAnalysis(FMEA)Tool

PATIENTWAITTIME
UnitedStates
SpecialCarePractice

Aim:TOMINIMIZEPATIENTWAITTIMEFROMTHEMOMENTTHEYCHECKINFORTHEIRAPPOINTMENT.
ProcessData
Date:10/03/2006
Step

Description

PatientTelephoneCalltoScheduleAppointment

FailureMode

Causes

Patientkeptonhold,lostcall, Operatorisoverwhelmed,
unansweredphone,closed
Poorlytrainedstaff,unclear
forlunch,wrongextension.
jobdescriptionand
proceduralguidelines.
Multipletypesofofficephone
callsenteringononeline:
"Push#2for???"

Effects
FrustratedPatient/Staff.
Improperscheduling.Hectic
officeroutine:"Somebody
scheduleline2!"Disrupted
officeflow.

Step

Description

ReviewPatientAppointmentHistories,PatientandAccountStatus.

Occ Det Sev RPN Actions

4

10

280 DedicatedPersonneland
phonelineforappointment
scheduling:nofiltering,that
isrollinglinestomultiple
unrelatedworkstations.
Maintaininghighlytrained
anddedicatedScheduler
withclearprocedures
outlinedandadequate
staffing.

FailureMode

Causes

Effects

IfPatienthasanerratic
schedulinghistoryasin
ReschedulesorNoShows,
theymustberemindedofthe
Cancellations/NoShowPolicy
andtheconsequencesofnot
arrivingontheexpectedday
andtime.

Noncompliantpatient
(Dangerous).
Elderly/forgetfulpatient.Lack
ofcommunicationbetween
caregiver/transportationand
patient.

Delaysinseeingother
patients.DisruptioninOffice
RoutineandSchedule.
LoweredIncomeand
Productivityfromstaff.
Disgruntledstaff.Trendsare
veryimportanttoobserve
anddealwithatalllevelsand
interfaces.

45 Clearandexplicitguidelines
fornoncompliancemustbe
communicatedinwritingas
handoutstopatients,posted
policyinofficeandverbally
addressedduringallrelevant
conversationsbyallstaff
includingandespeciallythe
physicians.

AccountStatusreviewis
necessaryforidentifying
noncompliantpatients.The
patientwithagoodpayment
historywillreflectthesame
behaviortowardsmedical
compliance.Makepayment
arrangementsandkeeping
themuptodate.

Noknowledgeofoutstanding
accountbalance,poorpatient
information.Lowincome
level.Embarrassedto
addresstheissue.Billing
mistakesnotthepatients
fault.

Increasedpatientstressand
noncompliance.Disruptionof
officeroutineandschedule.
Lostincome.

48 APatientElectronicdatabase
thatisaccurateandupto
datewithcompleteand
concisePatientappointment
andaccounthistoryavailable
toadedicatedappointment
scheduler.

Patientisnotactive.Doesnot
havePCPorisassignedto
anotherPCP.Donotaccept
patientsinsurancecoverage.

Patientnotknowledgeableor Poorornoreimbursment.
misinformed.Patientistrying
toreceivetreatmentwithout
fulfillingtheircontractual
responsibilities.

56 APatientElectronicdatabase
thatisaccurateandupto
datewithcompleteand
concisePatientappointment
andaccounthistoryavailable
toadedicatedappointment
scheduler.

Step

Description

SchedulePatient

Occ Det Sev RPN Actions

FailureMode

Causes

Effects

ImproperAppointmenttype.

Lackofclearguidelinesfor
Schedulerforsetting
priorities.Lackofclear
appointmenthistoryavailable
toscheduler.Lackofclear
understandingbypatientas
towhytheyarecalling:"The
Doctorwantsmetocomein."

DisruptedPatientflow.
Disgruntledpatientandstaff.
Lostincome.Doctorspissing
andmoaning.

NotthePatientsPCPornon
participating.

Changeincoverageor
employment.

Nonpaymentanddisrupted
officeschedule.

Step

Description

PatientTelephoneRegistration

FailureMode

Causes

InaccuratePatientFinancial
Information.

Lapsedorchangedcoverage, Possiblenonpayment,
changeinemployment.
especiallyifitisaHMOand
patientisnotassignedto
physician.Rebilling,lost
incomeandinefficientuseof
employeetimeandpoor
moral.

Effects

Occ Det Sev RPN Actions

16 Standardized,structured
patientSchedulewithFixed
timeslotsforeachtypeof
visit.Clearunderstandingby
scheduleroftimeframe
requiredforeachtypeof
visit.APatientElectronic
databasethatisaccurate
anduptodate.
108 Confirmpatientinsurance
coveragewithcarrier.

Occ Det Sev RPN Actions

2

http://app.ihi.org/Workspace/tools/fmea/ProcessDetailDataReport.aspx?ToolId=4294&ScenarioId=5125&Type=1

16 Confirmingpatient
informationwithboththe
patientandtheinsurance
company.Electronic
databasethatisaccurate
anduptodatewithcomplete
andconcisePatientmedical,
appointmentandaccount

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9/14/2015

InstituteforHealthcareImprovement:FailureModesandEffectsAnalysisToolProcessDataReport
history.

InaccuratePatientMedical
Information.

Patientnotclearwhythe
"Doctorwantsmetocome
in".Schedulerdoesnotcross
referencepatientmedical
historytoconfirmproper
appointmenttype.

Step

Description

RunDailyAppointmentConfirmation

Disruptedofficeflowand
schedule.Lostincome,
unhappypatient/staff.Return
foranunnecessaryvisit.

FailureMode

Causes

Wrongappointmenttype
madeduringcurrentday.

Poorpatientinformation
Disruptedscheduleand
availabletoscheduler.Lack disgruntledpatientsandstaff.
ofpatientknowledge.
Schedulerrushedtomake
appointmentanddidnot
confirmwithmedicalrecords.

Effects

Step

Description

Patient24hourpriortoappointmentreview,MedicalandAccount
Status.
Effects

Occ Det Sev RPN Actions

3

FailureMode

Causes

Requiredpatientmedical
informationfornextday
appointmentnotonhand,i.e.
Labs,reports,authorizations,
etc.

Breakdownin
Revisit,orwrong
communicationswithother
appointmenttype.
officesorpatient.Requestby
Physicianforinformationnot
followedthroughon.

Accountnotuptodate.

Patientforgot.Noncomplant Lostincome.Disruptedoffice
patient.
signin.

Step

Description

PatientAppointmentreviewbyPhyscianandMedicalAssistantfor
nextdayapptiontment.

FailureMode

Causes

Effects

Physicianandstaffnot
preparedfornextdays
patients.Physicianand
medicalassistantneedto
establishaCarePlanfor
eachpatientdetailingchain
ofeventsoncepatientis
broughtback.

Hecticpatientcare.Staffnot
knowingwhattoexpector
secondguessingwhatthe
physicianhasplanned.

Poorhealthcare,disrupted
officeflow,stressedstaff,
patientexperiencesan
unorganizedanddisrupted
officeandlossesfaithincare
beingprovided.

Step

Description

Requestrequireddocumentation.

FailureMode

Causes

Inadequateorincomplete
documentation.

Forgottenbypatient.Notsent Disgruntledpatientand
fromLab,Ancillaries,etc.
disruptedofficeschedule.

Effects

Step

Description

ConfirmAppointmentDaily.Requestpaymentandremindnon
compliantpatientofCancelationPolicy.

FailureMode

Causes

Accountnotuptodate.

Noknowledgeofoutstanding Lowornoreimbursment
accountbalance,poorpatient
information.Lowincome
level.Embarrassedto
addresstheissue.Billing
mistakesnotthepatients
fault.

Effects

128 Step5,6,and7.Confirming
patientinformationwithboth
thepatientandtheinsurance
company.Electronic
databasethatisaccurate
anduptodatewithcomplete
andconcisePatientmedical,
appointmentandaccount
history.

120 Standardized,structured
patientSchedulewithFixed
timeslotsforeachtypeof
visit.Clearunderstandingby
scheduleroftimeframe
requiredforeachtypeof
visit.

Occ Det Sev RPN Actions

160 RemindPatientduring
appointmentconfirmation
call.Contactothers
responsibleforinformation.
Electronicdatabasethatis
accurateanduptodatewith
completeandconcisePatient
medical,appointmentand
accounthistory.
16 RemindPatientduring
appointmentconfirmation
callofnecessitytomake
paymentatofficevisit.

Occ Det Sev RPN Actions

3

60 Reviewofmedicalchecklist
andpatientchartwith
medicalassistantandgain
anyadditionalinformation
physicianrequiresbefore
appointment.Makesure
properstaffingisavailable
fornextday.

Occ Det Sev RPN Actions

3

96 Properlytrainedstaffwith
clearandspecificjob
descriptions.Checklistfor
recordsrequests.Electronic
databasethatisaccurate
withcompleteandconcise
Patientmedical,appointment
andaccounthistory.

Occ Det Sev RPN Actions

3

60 APatientElectronicdatabase
thatisaccurateandupto
datewithcompleteand
concisePatientappointment
andaccounthistoryavailable
toadedicatedappointment
scheduler.

CalculatedTotals
TotalRiskPriorityNumberfortheprocess

1209

Occ: LikelihoodofOccurrence(110)
Det: LikelihoodofDetection(110)
NOTE: 1=VerylikelyitWILLbedetected

10=VerylikelyitWILLNOTbedetected

Sev: Severity(110)
RPN:RiskPriorityNumber(OccDetSev)

http://app.ihi.org/Workspace/tools/fmea/ProcessDetailDataReport.aspx?ToolId=4294&ScenarioId=5125&Type=1

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Annotation
None

http://app.ihi.org/Workspace/tools/fmea/ProcessDetailDataReport.aspx?ToolId=4294&ScenarioId=5125&Type=1

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