Haslam College of Business - Restructuring a Growing OB/GYN Practice

The following is the profile of an organizational action project conducted by Jaclyn van Nes, a member of the Haslam Physician Executive MBA, Class of 2016.

CHALLENGE: Expanding any medical practice involves more than a few growing pains. While the addition of new physicians typically produces long-term benefits—such as lightening patient loads for current providers—short-term challenges can sabotage success. For Women’s Specialty Care (WSC), a Knoxville, Tennessee, obstetrics/gynecology practice located at the main University of Tennessee Medical Center campus, the decision to add four new physicians in 2015 was made, in part, to adopt a variation of the laborist, or obstetrics hospitalist, model.

The OB/GYN hospitalist approach ensures that a fully trained OB/GYN will be physically available—with no assigned tasks or responsibilities elsewhere—to manage patients who present to labor and delivery. Since WSC is aligned with a teaching hospital (the University of Tennessee Graduate School of Medicine) the laborist-like model also made it possible for four physicians in the practice to incorporate academic goals with the Department of Obstetrics and Gynecology.

While the new model produced immediate benefits (such as consistent coverage in labor and delivery), it also presented challenges in five areas:

• Location: There was an initial concern that more space would be needed to accommodate the new providers at the practice’s main office on the UT Medical Center campus. WSC physicians also provide care at four satellite locations.
• Technology: Reliance on outdated processes and computers—which, already was causing delays and frustrations—increased with the addition of more providers.
• Furnishings and Flow: The office furnishings and work flow—both essentially the same as when the practice was founded in 2004—needed updating to keep pace with the growth.
• Schedules: Negotiations were needed to determine a balanced coverage schedule.
• Marketing: An updated marketing strategy was needed to attract new patients.

PROJECT: To meet the current challenges—and position the practice for future growth—WSC obstetrician/gynecologist and Medical Director Jaclyn van Nes created workable solutions using lean methodologies and marketing techniques. Her Organizational Action Project systematically addressed each challenge facing the growing practice.

PROCESS: First, van Nes used a sticky note board to map out a workable daily schedule, incorporating all five locations staffed by WSC providers. Since all provider contract requirements could be met within the schedule and the existing space, she determined there was no immediate need for additional space.

Next, van Nes performed a lean manufacturing workflow analysis to identify inefficiencies (such as using paper encounter forms before entering information into electronic medical records, or EMR) and find ways to minimize or eliminate any “double work” currently performed in the practice. Van Nes presented her findings to the office staff, information technology department, and hospital administration. As a result, the office team leader developed a much faster and essentially paperless check-in process, decreasing check-in times from 2 to 5 minutes per patient to approximately 15 seconds. In addition, patient forms were added to the practice website, saving time by allowing patients to fill out required forms in advance of their visit. The office also was equipped with more user-friendly laptops. Finally, due to the workflow analysis results and technology upgrades, more than half of the providers now use digital—not paper—documentation, significantly reducing the workload for the nursing staff.

Van Nes then conducted a patient flow analysis (PFA) at the practice’s main office to help identify inefficiencies and improve care delivery processes. Using the PFA results and the office floor plan, the office layout was redesigned to improve efficiency and accommodate additional physicians and patients. In addition, a portable lab kit was prepared to allow for lab draws in patient rooms and the storage closet was organized for better inventory management. Finally, new signs, office flooring, and furnishings were installed.

The final two challenges were addressed by creating a rotating call and clinic schedule (agreed upon by all providers) and by making research-driven marketing decisions (including updates to the WSC website and a new campaign promoting labor and delivery).

RESULTS: The practice restructuring project resulted in better quality of life for the physicians, the ability to see more patients more efficiently, and overall work and patient flow improvement at WSC. In addition, the practice is well positioned for future growth and is attracting new patients through its retooled and research-based marketing efforts.

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