Waiting in a doctor’s office probably isn’t your idea of a good time. And while clinical teams do their best to stick to their schedules, sometimes appointments run behind. For patients who are waiting as a result of these delays, they may ask themselves: “Will I be in this waiting room for five minutes...or thirty?”
A group of nurses at Levine Cancer Institute recognized this issue. So they wanted to find a way to provide up-to-the-minute notifications about a doctor’s waiting time. They had heard about other departments who used a whiteboard with up-to-date wait times for each patient. Hearing of the whiteboard’s success, they implemented the method themselves and immediately heard feedback on improved patient satisfaction, demonstrating that sometimes the most effective solutions are also the simplest.
Rare diseases — but a common problem
At Levine Cancer Institute’s Rare & Complex Clinic for Sarcoma and Orthopedic Oncology, patients have questions. Lots of them. After all, they’re dealing with cancer diagnoses that are highly specific and require specialized surgical intervention. The department’s doctors and nurses try to answer every question — but they know that doing so will likely cause their appointments to run long and increase waiting times.
“We see higher wait times because we’re so specialized,” explains Mackenzie Domske, RN. “And a lot of the feedback from patients had to do with them not being notified of their wait time.”
This can be particularly stressful for patients who might have another appointment scheduled later in the day. If a patient could just be told that their wait is going to be 30 minutes, maybe they could head over to another department first — or even head over to the coffee shop in the lobby without worrying about missing their appointment.
Each quarter, units get information about patient satisfaction known as Press Ganey scores. These scores are based on patient survey results — and in 2016, the Rare Complex clinic scored in the 54th percentile in terms of informing patients about their wait time. For a group dedicated to patient satisfaction, this was a major blow.
“We knew we had to get an action plan,” said Domske. “Whenever our patients aren’t happy, we need to find a way to fix it.”
Simplicity wins out
The Rare & Complex Clinic team wanted something affordable and easy to use. So the committee heading up this plan visited a few other departments within Levine Cancer Institute to get some inspiration. They saw a few offices that were finding success with whiteboards that showed “real-time” wait times. Intrigued, they began adapting that idea for their department.
“We started out very arts and crafty with a generic peel and paste whiteboard,” explains Domske. “It includes columns with physicians’ names, then next to each name will be a column that says their wait time, if there is one.” The timing column is color-coordinated so that higher weight times are written in red while lower ones are yellow. This helped create a highly visual representation of wait times
“The whiteboard seemed like an affordable way to test the idea, and if we got positive results we would be able to present to upper management in hopes of getting something more permanent,” explains Heather Parker, BSN, RN and Unit Based Council (UBC) Chair, another member of the committee.
“We pretty much saw instant results,” explains Parker. “Patients were actually verbalizing to the staff that they liked the board and were happy to have up-to-date wait times available.” And the Press Ganey scores supported this — bumping up to the 81st percentile in 2017 and then to the 94th percentile in 2019. The level of satisfaction in terms of waiting time information has remained high so far in 2019 as well.
Sharing their solutions
This simple whiteboard has made patients much happier and led to fewer questions for the front desk. Instead of being disrupted by frustrated patients, everyone in the department can instead focus solely on providing high-quality care.
“Exciting ideas like this are contagious,” says Domske. “Already we’re hearing about patients in other departments asking for wait time boards. We’re thrilled. Because when patients are happy, we’re happy.”
For their efforts, their department won the Heart of Nursing Award for Most Improved UBC for Central Division. Now they’re committed to sharing these learnings so that other departments at Atrium Health can keep patients informed about their wait times.
“We saw how much it was loved in our Rare & Complex Clinic, so now we have a whiteboard going for the Head & Neck Clinic down the hall,” explains Domske. Like Rare & Complex, Head & Neck diagnoses are highly specialized, so their department dealt with many of the same wait time problems. Now they have the same solution to boost patient satisfaction.
Seeing an idea through — from the brainstorming stage to actual successful implementation — has empowered these nurses to continue coming up with innovative solutions for common problems.
“It was really satisfying as a department to actually see something like this come together,” says Parker. “It sparked everyone’s creativity and cemented the fact that whenever we have a problem, we can find a solution. It’s encouraged our staff to push more new ideas and get things done.”
