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Success Story: Implementing Strategies to Optimize Efficiency and Workflow to Improve Physician Satisfaction

Learn how a HealthPartners clinic in St. Paul, MN, employs strategies that standardize necessary activities during a patient visit to reduce workloads, yield greater satisfaction for the care team, and improve the patient experience.

What Was the Problem?

HealthPartners wanted to support physicians' and clinicians' joy and passion for the practice of medicine by intentionally reducing the time spent working. HealthPartners uses the American Medical Group Association (AMGA) Physician Satisfaction with Practice Survey to benchmark against other similar organizations that use AMGA's survey and identify areas for improvement. One subject area of the survey, “Time Spent Working,” correlates highly with HealthPartners care group's overall satisfaction. This subject area includes administrative work done outside of the time physicians and clinicians spend directly with patients.

Developing the Intervention

“It would be great if decreasing time spent working only required a single work plan or initiative; however, we learned our approach must include multiple initiatives working towards the same goal.”—Nance McClure, JD

The intervention to improve satisfaction included the following impactful strategies:

  • Standardized workflows and stable teams: HealthPartners clinics use a “care model process” that defines a standard set of workflows for delivering evidence-based care. The focus is on procedures and protocols for care teams that provide a consistent clinical experience for patients. Care teams may be composed of a clinician, rooming nurse, receptionist, and others, such as a pharmacist or dietitian. The goal is to make the best use of collective team skills. This collaboration results in enhanced communication to ensure that care is well-coordinated and responsive. Teams plan for patient interactions in defined cycles that include scheduling, pre-visit planning, check-in, visit, and post-visit. Defining the elements of the interaction with patients allows the care team to anticipate patient needs, remind patients of health issues, and provide follow-up after the visit.

    For example, pre-visit planning may include identifying preventive care services that will need to be provided at the visit and contacting the patient to schedule lab tests before the visit so that results are available for review during the visit. In addition, medication reconciliation and history of patient illness are covered during the rooming process to leave more time for the clinician to discuss other concerns with the patient. During the visit, the team uses the electronic health record (EHR) to address the patient's health maintenance or chronic care needs, arrange prescription refills, and schedule future appointments.

  • Collaborative and streamlined documentation: Continual improvements achieve more consistency and clarity of clinical documentation. HealthPartners tries to standardize where possible and customize when needed to meet individual patient needs. Some successful approaches include judicious use of best practice alerts (BPA), 40+ templates housed in the EHR for collaborative documentation between nurse and clinician, co-located workspaces, wider monitor screens, and printers in exam rooms. Also, visits in which the registered nurse (RN) and physician are in the room at the same time make for a more meaningful experience for patients, allowing the clinician to spend less time documenting. During the shared visit, the documentation template selected from the EHR identifies the areas the nurse can document.

  • In-basket management: Similar to making progress in the area of documentation, work to efficiently manage in-baskets is ongoing. Eliminating “blinded” in-baskets (only visible to one user) for clinicians along with consolidation and standardization of folders are effective approaches. Unblinded in-baskets allow the work to be redistributed across entire care team so it is not resting solely on the clinician. The intent is to have as many messages as possible handled by someone other than the clinician, allowing them to only review what they need to see. For example, the rooming team members can prioritize messages for review and handle non-emergent messages appropriately. This is possible due to consistent training and resources such as the Test Results Guide. Specific action was also taken to streamline test results that collect in the in-basket.

Results

The practice saw meaningful and measurable time savings.

Other benefits:

  • Less friction when a team member needs to switch teams. Consistent or stable care teams coupled with standardized workflows achieved with the care model process makes switching teams when needed due to turnover, sick days, or vacations a seamless process.

  • Fewer patient calls about lab results. With better in-basket management, about 95% of lab test results are released to patients automatically within 4 hours via the patient portal. This ultimately reduced the number of calls received from patients wondering when they would receive their results.

Care teams are continuously innovating and improving to build upon this foundational work. These initiatives and others have helped move HealthPartners from the 13th percentile in 2005 to 61st percentile in 2016 in the area of “physician satisfaction with time spent working” in the AMGA survey. “Overall satisfaction with practice” for the same period increased from the 23rd percentile to the 84th percentile. HealthPartners' vision is “health as it could be, affordability as it must be, through relationships built on trust.” The group recognizes that to achieve this vision, joy and passion are fundamental to practices and that a balance in both personal and professional lives is required for clinicians to be at their best.

About the Organization

HealthPartners, an integrated health care organization providing health care services and health plan financing and administration, was founded in 1957 as a cooperative. It is the largest consumer governed nonprofit health care organization in the nation—serving more than 1.8 million medical and dental health plan members nationwide. The care system includes a multi-specialty group practice of more than 1800 physicians that serves more than 1.2 million patients. HealthPartners is headquartered in Bloomington, MN, with clinics and hospitals across Minnesota and Wisconsin.

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Article Information

Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships.

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