COVID-19 screening and triage: voices from the front lines
How one healthcare provider solved for disruption during the COVID-19 pandemic
Thanks to A.J. Jordan, PMP, Chief Operating Officer of Desert Sage Health Centers, who shares this inspiring story from the front lines of COVID-19 response.
On March 16, 2020, the first Monday after Idaho had confirmed cases of COVID-19, our community health center was flooded with calls and visits from concerned patients. We had to act quickly to meet patients’ needs in the face of a growing pandemic.
We asked ourselves: how can we (1) enable patients to keep social distance (2) keep sick patients as isolated as possible and (3) help patients feel more comfortable when they do need to come to the clinic for care. Could we create a clinic outside? We put a team together the next day to start planning a drive-in clinic.
Lean tools were essential to planning
Our team had multi-disciplinary representation, including clinical, quality, infection control, leadership and registration. We have been working with IBM Simpler Consulting for 18 months on process improvements, and we relied on the Lean tools and coaching from that journey. They helped us apply good design principles from the very beginning as we planned to launch this new service. The team started with the Lean flow cell model of 5S, one by one, standard work, pull systems and visual management, and we used those as the foundation for process mapping and design.
Over the course of the next four days, we developed an outdoor clinic process from check-in to check-out for an outdoor environment. Using Lean tools, we held practice runs, and we got it wrong. We did more practice runs with employees as test patients, and we got it wrong again. But each time we improved. By the end of the four-day planning and testing period, we had a comprehensive process map and standard work for eight key positions.
How the drive-in clinic works
Our drive-in clinic is open to all patients, established or new, on a first-come, first-served basis. We have parking spaces to serve 10 vehicles at a time. It is typically staffed by one provider, two medical assistants (MA), two registration staff, two support staff, and one clinic lead to oversee daily operations. One of our staff members instructs patients where to park and a greeter delivers the paperwork, which includes a registration form and a reduced fee application. The greeter also completes an intake slip to help our staff understand the reason for their visit at the drive-in clinic. Patients turn on their hazard lights when they’ve completed the paperwork.
We use visual tools, such as a visual management board and colored magnets on the cars, to help our team track patient flow through the process. We boosted our Wi-Fi signal so we had access to the EHR, as well as the ability to process payment and insurance information in real time.
What happened our first week
We opened the drive-in clinic to patients on Monday, March 23, less than one week after assembling our Lean Design team. With advertising limited to our Facebook page, we drew 108 total visits the first week: 100 patients had provider visits and eight had nurse-only visits.
Overall, about 55% of our volume is currently coming through the drive-in clinic. Our average flow time for each patient averages about 35 minutes to complete paperwork, payment, vitals, triage and clinical visit (this compares with an average of 60 minutes for a traditional clinic visit). We had one provider who saw 37 patients in one day alone (this compares with an average of 16-17 patients per day in our traditional practice). Our success and volume with this additional service line allow us to keep all our staff members doing meaningful work during a time when other healthcare systems are laying off non-essential staff.
The reaction from patients and the community have been overwhelmingly positive. Patients have been grateful, because some family practice clinics in our community aren’t taking patients with illness symptoms. We will see anyone; they don’t have to be established to come to us for sick care. One of our patients said, “All of your people are standing out in the cold to take care of us – God bless you!” We’ve had local businesses and individuals reaching out to us with donations of food, coffee, masks, and hand warmers. The random acts of kindness from within our community speak volumes about their gratitude for our efforts.
Sharing lessons learned
We’re still iterating daily and watching for ways to keep our processes tight, even when five cars show up at one time with multiple patients in each car. A relentless focus on planning and good design is the cornerstone of our success thus far.
All our design-team members commented that without being on our Lean journey, we couldn’t have put together this new service so quickly, and we wouldn’t have had the tools and systems we needed for such a successful launch. We are so grateful for the coaching we’ve had with Simpler. It matters now more than ever before.
It was a proud moment for our team to package up our design – elements like standard work, process maps, supply lists, lessons learned, and advertising materials – and make it available to other community health centers (CHCs) in the State of Idaho. Our hope is that any CHC can stand up a drive-in clinic in a fraction of the time that we were able to do it. The CHC community in Idaho is a close-knit group, and it only made sense for us to share our work and pay it forward.
The drive-in clinic answers an important need for our community right now, and we will continue to provide this service while it’s needed. We’re also exploring the opportunity to make this a permanent service if community feedback continues to be positive. We’ve designed it well so that it may be useful well into the future.
As a team in a small, rural healthcare setting, sometimes we struggle to think outside the boundaries of our current and past experiences. To meet the challenge of rapidly designing a new service line, we had to do everything differently. It was “forced innovation” – two words which don’t seem to go together. But this undertaking opened our eyes to what is possible by engaging in true “rapid improvement.” Throughout the past several weeks, our team realized that we can do something we’ve never done before, make it our own using the tools that we’ve learned, and create something wildly successful. We are excited to see what comes next.