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A No-Show Analysis: A Process Improvement Plan to Lower No-Show Rates. Lindsey Preston University of Kentucky Martin School of Public Policy and Administration Masters in Health Administration Capstone Project Spring 2008. Statement of Problem.

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a no show analysis a process improvement plan to lower no show rates

A No-Show Analysis: A Process Improvement Plan to Lower No-Show Rates

Lindsey Preston

University of Kentucky

Martin School of Public Policy and Administration

Masters in Health Administration

Capstone Project

Spring 2008

statement of problem
Statement of Problem
  • $612 million is wasted on non-attendance annually (Oladipo et al., 2007)
  • No-Shows
    • Hinder productivity and efficiency
    • Increase provider and clinical staff frustration
    • Provide less continuity of care
    • Interrupt critical treatment follow-up
statement of problem3
Statement of Problem
  • Pediatric patients have the highest rate of broken appointments
  • Shriners Hospitals for Children of Lexington, KY is a 50 bed pediatric orthopedic hospital and outpatient clinic
  • Provides free care and transportation for all patients
  • Shriners Hospitals for Children no-show rate continuously fluctuates
purpose of study
Purpose of Study
  • Identify problem areas that lead to Shriners Hospitals for Children’s current no-show rate
  • Identify effective process improvement solutions for lowering Shriners Hospitals for Children’s no-show rate
data collection
Data Collection
  • Existing data from May 2007 through January 2008
    • Provider type
    • Month
    • Time of day
    • Day of week
  • Interview data
    • 150 patients who showed for their appointment
    • 150 patients who did not show for their appointment
results
Results
  • Average no-show rate 13.4%
  • 1905 no-show patients in 9 month period
  • 5 problem areas
    • Attending physicians
    • Absence of appointment reminders
    • Short distance traveled
    • Long time between scheduling and appointment date
    • Short relationship with Shriners Hospitals for Children
attending physicians
Attending Physicians
  • No-show rate 15.4%
  • 1242 no-shows
  • Highest volume provider type
  • Case load vs. no-show rate
absence of appointment reminders
Absence of Appointment Reminders
  • 42% of no-shows did not receive a reminder
  • 16.6% of shows did not receive a reminder
  • 29% of all patients did not receive a reminder
short distance traveled
Short Distance Traveled
  • 90% of show patients live over an hour away
  • 25% of no-shows live within 1 hour
  • 11% of no-shows live in Lexington
long time between scheduling and appointment date
Long Time Between Scheduling and Appointment Date
  • 16.6% of no-shows were scheduled within 2 weeks
  • 36.0% of shows were scheduled within 2 weeks
  • 45% of no-shows were scheduled 3 to 4 weeks out
short relationship with shriners hospitals for children
Short Relationship with Shriners Hospitals for Children
  • 130 patients in Shrine system for 1 to 3 years
  • 34.6% patients showed for their appointment
  • 65.3% of patients did not show for their appointment
recommendations
Recommendations
  • Advanced access appointment systems
  • Patient education
  • Scheduling flowchart development
slide13
Advanced Access Appointment SystemAttending Physician and Time Between Scheduling and Appointment Date
  • Matches day-to-day appointment demand with appointment supply
    • 70% of appointments scheduled within 2 weeks
    • 30% of appointments scheduled after 2 weeks
  • Reduce no-show rate by 50%
  • Shriners Hospitals for Children unique culture
slide14
Advanced Access Appointment SystemAttending Physician and Time Between Scheduling and Appointment Date
  • Gustafson Change Model
  • Tension for Change
    • Staff attitude
    • Communication
  • Pilot Testing
    • Attending physicians
    • Discover kinks in system
  • Monitoring and Feedback
    • Continuous change
    • Risk free employee feedback
patient education distance traveled and relationship duration with shriners hospital for children
Patient EducationDistance Traveled and Relationship Duration with Shriners Hospital for Children
  • Patient Empowerment
    • Each visit is imperative
  • Disrupt Patient Care
    • How does my absence affect others?
  • Signed Agreement
    • Importance of appointments
scheduling flowchart development appointment reminders
Scheduling Flowchart DevelopmentAppointment Reminders
  • Correct Breakdowns
    • Cancelled appointments
    • 29.3% did not receive a reminder
  • Develop Process and Procedure
  • Employee and Patient Needs
    • Fast and efficient
    • Do patients know what to do if they need to cancel?
limitations
Limitations
  • Human Error
  • Real World Events
  • Single Investigator
  • Random Sample
  • Generalize to Other Pediatric Hospitals and Out-patient Clinics
slide18
Dr. Sarah Wackerbarth, Chair

Dr. Martha Riddell, Major Advisor

Dr. Dwight Denison, Reader

Tony Lewgood, Outside Advisor

Administrator Shriners Hospitals for Children of Lexington, KY

THANK YOU!