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The hepatology clinic at University of California, San Francisco, is an outpatient practice that serves patients with complex hepatic conditions, including patients who have undergone liver transplants. The busy academic practice books approximately 6,500 patient visits a year.
Clinic leaders initiated daily team huddles as a component of a broader Lean implementation, triggered in part by persistently low patient satisfaction scores. Facilitated by the practice manager, the team huddles are held each day at 9:30 AM and include the entire care team—attending physicians, fellows, nurse practitioners, physician assistants, and administrative staff. The team comes together for 15 minutes to discuss the agenda for the day. They identify any potential issues, such as a provider being out sick, and develop plans to minimize any repercussions, such as longer wait times for patients.
During the huddles, the team also reviews a status report for the previous day, prepared by the the practice manager from the electronic medical record each morning. The report includes four pieces of data that relate to the overall goals for the clinic:
Number of new and return patient visits.
Number of “no-shows” and the reasons for them (the staff contacts patients to inquire about the cause of missed appointments).
Average visit length.
Number and status of referrals received, both internal and external.
During the huddles, team members also identify any ongoing issues that are adversely affecting their daily work, such as inefficient patient rooming practices, difficulties consistently collecting copays, or delays in obtaining diagnostic test results. Once a problem is identified, team members suggest a potential solution to test, identify an individual responsible for implementing the solution, and determine a timeline to implement and evaluate the proposed solution. These staff-initiated solutions have resulted in rapid improvements to problems that contribute to delays for patients and frustration among care providers. If a problem cannot be solved by the team in daily huddles, it is escalated to the clinic leaders, who address the problem or bring it to the attention of medical center leaders.
The huddle also serves as an opportunity to recognize team members for their positive contributions to the clinic. The practice manager reads emails and comments from patients and shares results from the week's patient survey. According to Bilal Hameed, MD, associate chief of the clinic, the team huddles have resulted in many improvements that have boosted morale and job satisfaction, both among patients and across the team. “Our clinic staff has been empowered to identify problems and test solutions. Now they feel heard, respected, and an important part of the team. Providers get what they need for their patients and are less frustrated. It doesn't take six months or a year to fix a problem that affects their daily work. It's solved right away.”
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