Eliminating Subjective Conversations in Practice Management – The Real Value of RTLS Data
At CenTrak we draw from the real-life experiences of our team members to help our healthcare clients fully leverage the power of real-time technologies.
David Kame, MBA, MHA, Clinical Healthcare Consultant, details how we put this into practice. David spent more than twelve years in various healthcare administration roles, including Practice Administrator at Cornerstone Healthcare, Program Director at Healogics (Wake Forest Baptist Wound Care & Hyperbaric), Director of Primary Care at Randolph Health and Business Operations Manager at Novant Health. In these roles, he was responsible for improving efficiencies, increasing access, containing costs, and optimizing resources to enhance profitability and value-based care initiatives. Below, David shares what clinical leaders, such as administrators, directors and nurse managers should know about Real-Time Location Systems (RTLS).
Why should clinic administrators and healthcare leaders use RTLS?
More than likely, their primary goals are focused on increasing patient access to care, improving throughput, optimizing resources, providing exceptional quality of care and achieving 99th percentile customer satisfaction scores. Achieving one of these goals is phenomenal. Achieving all of them simultaneously is far more challenging, requires balancing competing factors and understanding how to optimize all your resources. It requires a multi-faceted approach.
Seeing more patients each day is often limited by constraints such as exam room capacity, staffing, bottlenecks and an inability to understand what is blocking you from achieving your goals. As the name suggests, RTLS provides real-time visibility into your clinic or department’s operations. The advantage is that you can address potential issues in real-time rather than waiting for a frustrated provider, angry patient, or excessively crowded lobby.
If I had an RTLS-driven patient flow system at my fingertips, it would have been a dream come true! The potential is unlimited on what you can do with it, the impact it can make and how it can help solve problems you are facing on a recurring basis.
How can RTLS help with reducing variability in the patient’s experience?
This is something that frustrates healthcare leaders is the challenge of delivering a consistent experience, to every patient, every visit. Doing so requires that all staff are operating in a consistent manner, delivering a consistent quality of care and doing it in a consistent timeframe.
Using RTLS allows you to have accurate, real-time time and historical data that covers time with patients, time a patient is unattended in an exam room, staff interaction times with a patient, time a patient waits for a staff member, how long a patient is in each phase of their clinic visit and how long each visit lasts. Inconsistent delivery of care in any of these facets is quickly noticed by patients, may frustrate a patient and can impact your ability to efficiently deliver quality care. For example, if you have six nurses in a clinic who traditionally spend seven minutes with a patient before the provider enters the room you understand what is normal and patients know what to expect. However, when one of the six nurses is averaging four minutes or eleven minutes when the average for the role is seven, RTLS gives you insight into something being different. Is it that nurse’s process? Is he or she providing better or worse care? Are they too brief or too chatty with a patient? The opportunity to leverage RTLS data to coach a staff member, rather than penalize them, is extraordinary. I’ve seen this work, first-hand, in numerous clinics at Atrium Wake Forest. It has helped nursing managers and clinic administrators identify challenges a new hire might be having or if a staff member’s performance has suddenly changed that there might be something more going on in their life.
Additionally, understanding what is reasonable through the RTLS data can help when creating or revamping standard operating procedures (SOPs). For example, how long should it take for a CMA to get a patient’s vitals?
Can you explain how RTLS-based patient flow can assist in driving patient throughput?
RTLS provides unmatched in the moment visibility and awareness. It can be a lot to consume but if you care about the patient and their experience, that visibility and awareness is powerful.
Let’s think about a traditional visit to a clinic. The first stop is registration. Using RTLS, a leader can determine traditional waiting for registration and time it takes to process the registration. They can utilize real-time stats or quickly glance at a display or their desktop to determine if things are backing up. After registering, the patient sits back down and waits to be called to the back through the magical double doors into the clinic. This is often where patients get frustrated. What can a leader see? They can see how long patients traditionally wait and how long waits are currently, along with how many are waiting. They can see which providers or appointment types have the longest and shortest waits. Understanding the top performers allows you to take best practices from those groups, whether it is process, scheduling or anything else, and apply it to the lower performing providers, departments, etc.
Of course, once you go through the magic double door patients have vitals taken. Are there bottlenecks with your vitals stations? Are certain stations being used more than others? Is there enough equipment at each station to efficiently process the patient load?
Next, the nurse or medical assistant takes the patient to the exam room. They quickly perform their medication reconciliation, understand the reason for the visit and complete any additional vitals or tests needed. Then the patient waits even more for the provider. As with anything, some providers are prompt and have short wait times, others have much longer times. What is driving the variation in those times? Is a provider too detailed with the patient or not informative enough? Does the provider attempt to cover too many issues for the patient in one visit? Should a provider be billing a higher level of service due to the length of visits they have that covers more than one issue? If your provider is consistently behind and spends twenty minutes with each patient but patients are scheduled every fifteen minutes, you have a problem. The provider must be more efficient or appointment times reconfigured, otherwise, by the end of the morning or afternoon the provider is quite far behind.
This data can help you make better in-the-moment decisions, such as knowing what patient should be seen next, or which patient may become unhappy because they are waiting too long. Having visibility into patient flow in real time also enables you to use your resources better; for example, you can see which exam rooms can be prepped for the next patient.
How else can RTLS data improve patient flow?
The possibilities are endless. Identifying trends is vital to success. You can’t make positive changes to processes without knowing the root cause of your problem.
RTLS software can help provide the data for quick visual analysis using heat maps. These highlight busy times, days or times within specific days while also highlighting the areas where capacity exceeds demand. The heat maps can be compared across different periods of time to quickly determine if a process change has favorably or unfavorably impacted the clinic. Additionally, the goal should be to level volume and reduce the peaks and valleys throughout the day.
I can look at wait times – are they increasing or decreasing, do they differ by an hour in a day, or maybe by the service line? All this information is necessary to find the root causes of delays and how to fix them. As a healthcare operational leader, I paid close attention to deviations between scheduling blocks and reality. The ability to access or build a heat map to illustrate bottlenecks is an incredibly helpful tool. Most of the time the outliers were caused by not following standard operating procedures, which could be fixed through a stand-up meeting or, if needed, additional staff training – but you need to know when and in what circumstances it happens. With RTLS data, you can drill down to this level of information.
What is the most important aspect of RTLS data?
What is so powerful about RTLS data is that it is automatically collected – which means it is timely, accurate, and unbiased. You are not relying on staff to manually notate an event as humans are more prone to error. These three factors are critical in making any process improvements without added labor costs.
Can you elaborate on each of these factors?
The timeliness of data allows an operations leader to make changes instantly, to be proactive, not reactive, so we can address any issues before they become a reason for service recovery. Previously, time studies were needed that required extensive labor allocations to visualize and synthesize the data. With RTLS, you collect the data continuously without the needs for human labor and it can collect far larger amounts of data in a much faster manner.
The accuracy of data – Many of us have conducted process improvement exercises using stopwatches. However, we all know that people behave differently under the pressure of direct observation, and data generated through observation represents just a fraction of time. With RTLS, data is collected continuously and for all patients simultaneously. This is important not only to identify root causes but to validate process change decisions and to continue tweaking them. It allows for baselines to be set and objectively evaluated. Process improvement should never be a one-time exercise.
The unbiased nature of RTLS data is a critical factor in driving change, especially when it comes to the human factor. Have you ever had a conversation with a provider when their scheduled patient visits are getting off track? You probably heard that the room was not ready, or that CMA was talking with the patient too long. However, when you can present to a provider evidence-based information regarding their impact on patient flow delays and the downstream impact of those delays on other patients or other services, a potentially hostile conversation turns into a productive discussion. As scientists and data-driven individuals, physicians start asking questions – how can we improve the process, what can I do differently? I found it very stimulating – the sooner you can eliminate subjective conversations in your practice, the faster you can drive change, without hurt egos or an “it’s not my fault” mentality.
How about patient satisfaction? How can RTLS help?
The closer we can match patient expectations regarding visit start time or the time they spend with the provider during the visit, the more satisfied patients are. By leveraging an RTLS-enabled patient flow solution you can make your patient experience more consistent and reproducible, and that adds value to patient visits. In addition, it also simplifies the work of nurses and doctors, which in turn impacts staff satisfaction and allows them more time with patients, so it is a win-win situation.
Thank you for sharing your perspective on the value of real-time technologies on patient flow.
Any time! If there are any practice administrators, directors or executive leaders who would like to discuss in more detail how to leverage an RTLS system to reduce wait times, increase access, and improve patient and staff satisfaction – contact us to set up a demo or read more about CenTrak’s Clinical Workflow Solution!