OUTPATIENT FLOW OPTIMIZATION - The redesign and implementation of non face-to-face flow systems

• Published in: International journal of integrated care 2016-12, Vol.16 (6), p.306
• Main Authors: Doretto, Pilar, Gómez Rojas, Rafael, Muñoz Falcón, Luis, Sanclemente Dalmau, Montserrat, Álvarez del Castillo, Manuel
• Format: Article
• Language: English
• Subjects: Biometrics; Communication; Cost control; Diagnostic tests; Hospitals; Optimization; Perioperative care; Primary care
• ISSN: 1568-4156; 1568-4156
• DOI: 10.5334/ijic.2854

Introduction: In a global context of increasing demand for health care and the greater demand on the quality of care, our health systems are being challenged to maintain high quality standards. In order to meet these expectations, it is necessary to apply increasingly efficient management models that safeguard and improve the user’s perception of the attention received.Limited public or private resources in health institutions urge us to seek their optimization by implementing more effective alternative modus operandi. By incorporating technological advances in the sector, particularly through new communication systems, we are given an opportunity to substantially alter doctor-patient or administration-patient relations whilst promoting co responsibility in the health process.With these premises, and a clear commitment to the patient, a project is born focused on the outpatient area of the Hospital Sant Joan de Deu de Martorell in Barcelona. The aim is to simplify the highly complex flow of patients, which increases the cost of the care process due to its numerous associated administrative procedures. This gives rise to a negative impact on the end user’s satisfaction. Using the basic principles of ‘LEAN’ methodology and process reengineering in the areas of surgical scheduling, outpatient visits, admissions and certain outpatient procedures, waiting time targets have been reduced and improved levels of accessibility to specialist consultants were established.Methods: The project is defined initially by focusing on the outpatient area, however with a view to expanding it into other hospital areas. The project has been undertaken in close collaboration with primary care teams resulting in the setting of the main following lines of action:1. Review and redesign of patient care systems, from hospital admission to scheduling consultations and diagnostic tests by applying reduced flow time and optimization of resources.2. Incorporation of non-face-to-face service processes by implementing mobile-phone technology as a way of bi-directional communication with the patient.3. Creation of a preoperative care unit, with a single preoperative interaction as a specific approach in the pre-surgical procedure.4. Application of biometric signatures, with informed consent, and the elimination of paper medical records.Results: In less than a year, after the implementation of the actions described, the results exceeded the expectations created and effected directly and indir