Health care isn’t easy. When faced with a long-standing problem that includes many facets, it can feel too complex and overwhelming to solve. How do we tackle this? Where do we even begin? How do we overcome the cultural issues that led to the problem in the first place?
These were tough questions a team with the OSF HealthCare Illinois Neurological Institute had to answer as they worked to increase access to the Epilepsy Center, manage referrals and ensure individuals are matched with the right provider at the right time.
Our answer? Bite by bite.
As part of our effort to foster a culture of continuous improvement, Performance Improvement, a part of OSF Innovation, coaches teams of leaders on improvement methods to spot issues, determine what’s not working and then develop solutions that lead to better work processes and patient care.
One of those methods is called A3, a communication and problem-solving tool similar to a storyboard that fits on an 11–by-17-inch sheet of paper. It is used to share a summary of all project activities, including the background, current state, analysis of the current state, goals, countermeasures, desired state, follow-up and lessons learned. The idea is to help teams stay focused on the information needed to design plans of action.
A3 in action
For OSF INI, there were a variety of issues preventing a streamlined and enhanced scheduling process. The group hadn’t standardized how neurology patients are scheduled. The Epilepsy Center didn’t have enough providers to manage patient demand. Sometimes people were incorrectly referred to the center. And the scheduling technology used wasn’t optimized for best results.
“There are a lot of processes that take place behind the scenes that allow for patients to be scheduled,” said Greta Torry, vice president of the Neurology Service Line for OSF HealthCare. “You can have the best scheduling platform available, but it won’t matter if you don’t have the right process infrastructure in place.”
Using the A3 problem-solving technique, the OSF INI team outlined their problem to be solved, and why a solution was needed. They gathered voice as they worked through the issue, analyzed the data, planned a change, tested it, studied the impact and determined if adjustments needed to be made. All of this information was laid out on an 11-by-17-inch document as a simple way to report what’s taken place.
“This is really an attractive way of solving a problem because it closely mirrors my day-to-day practice as a physician,” said Deepak Nair, MD, director of the Neurology Service Line for OSF HealthCare. “Similar to conducting a patient evaluation, we are acquiring historical data of a problem, identifying necessary data and synthesizing information to arrive at a diagnosis or solution, leading to a treatment plan. This process makes the business side of care easier to take on.”
Following the use of A3, OSF INI made several changes that have led to significant results. This includes a reduction in the number of neurology visit types from 54 to 18 and an improvement in the way patient referrals are made to the Epilepsy Center. The team developed clinical criteria to identify patients who need urgent appointments with epilepsy providers. And this work has resulted in an increase in new patient access to the Epilepsy Center from nine new patients in March to 20 in April.
Beyond the numbers
Outside of improvements leading to schedule optimization, use of A3 has also resulted in other positive outcomes. Leaders are now looking at data to make informed decisions. They are identifying more improvements to transform OSF INI, and they will use A3 to address new problems.
“Having tough conversations without this tool as a guide would have been very intimidating. I’m not sure we would have come to any resolutions whatsoever,” said Debra Schultz, director of Operations for OSF INI. “However, by using A3, we’ve been able to easily make our case for change. It’s been amazing to watch how it’s leading to success in several areas.”