P2.Q326: “Outreach” to “Onboarding”: A Process Improvement Project to Improve Workflow Efficiency

Purpose/Objectives: Healthcare costs and efficiency of healthcare teams are critical topics in medicine. Our novel virtual-first multidisciplinary comprehensive care (VFMDCC) program for children and youth with special healthcare needs (CYSHCN) perceived barriers to workflow throughput and inefficiencies among healthcare team member tasks, resulting in patient/family dissatisfaction. We designed a project to optimize the efficiency of the workflow beginning from contacting and introducing families to the VFMDCC managed care Medicaid covered benefit (“Outreach”) through the first provider establish care visit (“Onboarding”).

Design/Methods: The VFMDCC program for CYSHCN launched in January 2023. During Q2 we noted anecdotal staff and family efficiency-related concerns. We began by process mapping our “Current State“ “Outreach” to “Onboarding” workflow. Through an iterative process, stakeholders identified workflow steps that represented “Waste” (DOWNTIME = Defects, Overproduction, Waiting, Non-utilized Talent/Things, Transportation, Inventory, Motion, Excessive Processing). After selecting solutions to eliminate waste, we engaged in process re-mapping to a the “Future State” process; we then implemented PDSA Cycle 1. We collected and incorporated feedback into workflow revisions prior to implementing PDSA Cycles 2-4. To demonstrate efficiency impact, we recorded baseline and post-implementation average patient time (using time study data), average staff time (using time study data), total “Onboarding” visits per month (reports in EHR), estimated patient/family cost reduction (using 133% of federal poverty level to estimate maximum salary eligible for Medicaid), and estimated staff cost reduction (using average salary/role).

Results: “Current State” process mapping revealed 132 unique tasks and 116 opportunities to reduce “Waste” (Figure 1). “Future State” mapping illustrated a more efficient workflow of 31 unique tasks. Following implementation of the new “Future State” mapped workflow, average patient time and average staff time decreased from 104 min and 144 min to 70 min (33% reduction) and 90 min (38% reduction) respectively. Providers conducted 129, 298, and 329 “Onboarding” visits pre-, 30 days post-, and 60 days post-implementation, respectively, translating to a reduction of 16.5% in staff time and 26% in patient time during “Onboarding” visits. Without process improvement implementation, 329 “Onboarding” visits would have required 832 hours of staff time/year (vs 695) and 532 hours of patient time/year (vs 395); this translates to a 59% decrease in total staff cost per provider “Onboarding” visit and 66% decrease in total family cost per provider “Onboarding” visit at 60 days.

Conclusion/Discussion: The VFMDCC for CYSHCN program, financed under a population-based health model, has the potential to greatly optimize health outcomes for numerous patients/families, but only following successful “Outreach” and “Onboarding.” Our workflow efficiency process improvement project significantly impacted staff and patient/family time and workflow throughput, thereby reducing staff overwhelm and patient/family disengagement from other family-focused experiences.