Human Resources Development and Training

CHAPTER 1—INTRODUCTION

Overview

This study examines a medical clinic’s organizational structure by integrating three conceptual models—Human Resource Development (HRD), Human Performance Enhancement (HPE), and Analysis, Design, Development, Implementation, and Evaluation (ADDIE)—for analysis and development of their business organization and future requirements.

Providing services for all consumers should be a focal concern for all businesses. However, there is limited research on how healthcare organizations design their businesses to enhance patients’ satisfaction beginning with their first interaction with a clinic. At the time of this writing, the COVID-19 pandemic has left businesses contemplating how to survive. In addition, the pandemic created a sense of urgency for healthcare providers to re-examine their business model, including creative ways to serve their patients.

Information technology has become critical permitting many ways for patients to select new medical providers and/or medical services. This paper does not proclaim to have exhausted every health care organization’s departmental assessment for improving patient care; however, it does speak to providers seeking an example for organizational development.

The return on investment is important for health care organizations therefore, this paper will illustrate how a clinic identified and determined fiscal benefits by re-organizing its operations to accommodate their patients prior to the pandemic.

Background

The regional eye care center used for this project is a real organization. A fictitious name was used to ensure the confidentiality of the organization and the parties involved. This eye care center depends on referrals from primary care providers to receive patients. Essentially, when consultations with a physician or other primary care practitioner indicate that the patient needs treatment from an ophthalmologist, that patient is referred to the regional eye care center. This means that the patient referral process is crucial for how the eye care center is introduced to patients. Rather, if a patient is referred to the eye care center, then this means that the patient has already seen a primary care practitioner who has determined that the patient should be referred. Devising a method to streamline referrals is crucial to delivering high-quality care to the patients. since again, most of the patients at the eye care center are there because they have received referrals. Thus, the research problem to be investigated is the system used to process patient referrals at the eye care center. This results in long patient wait times, as well as perpetual misunderstandings between the patient and healthcare providers regarding issues such as insurance, coverage, appointment times, and so on. This confusion has led to a drop over time in patient satisfaction rates. The clinical metric that will be evaluated for the present project, then, is patient satisfaction scores. On the basis of observations, it has been determined that the current patient referral process is the reason for dropping patient satisfaction scores. Therefore, the project will seek to improve the patient referral process as a means of improving patient satisfaction scores.

Performance Gap

The current patient referral processing model is reflected in the following diagram:

Figure 1

Figure Title Needed This Figure Table Style Needs To Be Changed & Re-named.

Step 1 . Most of these patients are seniors, and the process of treating them is for the most part straightforward.

Step 1A

Patients who are not registered or seen without a referral cannot be immediately seen by an ophthalmologist since they do have a referral. These patients tend to become upset while sitting in the waiting room, and they often dispute their cases with the front desk staff.

Step 2

If patients cannot contact their primary care providers and get a referral sent by fax, then they can either schedule a new appointment at the region eye care center or leave.

Step 2A

Patients waiting for faxed referrals tend to become anxious. As a result, they approach the front desk frequently, which creates a general atmosphere of disorder within the waiting room.

Steps 3-5

It is generally smooth sailing through these phases since they pertain to patients who do in fact have their referrals in order. However, it is worth noting that the wait time for the patient could be extended if the patient's appointment time passes while he/she is waiting for a faxed referral.

From the information presented by….., it can be seen that the process for addressing patients who come to their appointments without a referral is a concern. It is important to determine how to streamline processing for patients who arrive without a referral and then decide to contact their primary care providers to receive a faxed referral.

Framed in this way, perhaps there are a couple of solutions that could be pursued to resolve the identified performance gap. First, referrals could be received immediately by shifting from faxing to scanning and using e-mail to receive referrals. And second, the eye care center could adopt a policy of sending home patients who arrive without a referral. The current process is rather ad hoc, and it is stressful for both the patients and the healthcare providers. Ultimately, the current performance gap reflects inadequacies in the process of addressing the needs of patients who arrive at the eye care center without referrals.

Unfortunately, the ophthalmologist is not aware of the amount of personal time and profit that is lost because of this issue, not to mention the long-term impact on the eye care center’s reputation. At present, the front desk of the eye care center generally deals with the issue without bringing it to the attention of the ophthalmologist. However, this is taking its toll both in terms of the job satisfaction of the front desk workers and the satisfaction of the patients who come to the clinic.

As Rothwell (2005) wrote, “A performance gap is a difference between what is happening and what should be happening. A performance gap can also be regarded as a difference between the way things are and the way they are desired to be” (p. 126). In this context, the process at the eye care center regarding patients without referrals qualifies as a legitimate performance gap. In the case of the eye care center, the there are two possible solutions: (1) all patients to arrive with their referral paperwork or (2) provide patients that do not have a referral an easy and reliable way of receiving a referral once they have arrived at the clinic. As a result, the front desk staff has two distinct experiences with patients. On the one hand, while trying to be helpful to patients who arrive without referrals, they become agitated or anxious while they wait for their referral. On the other, for those patients who have all their referrals they are impacted by the negative atmosphere and disorder generated by those patients who did not arrive with a referral. Both situations may result in delays in scheduled appointments. Therefore, this situation clearly fits the definition of performance gap provided by Rothwell (2005).

The Step 2A loophole. An examination of the workflow processes within the eye care center indicated a key problem, identified as the Step 2A loophole. This loophole indicated that patients who arrive without referrals are permitted to retrieve their referral through fax from their primary care providers. This loophole is problematic for three reasons. Firstly, there is no guarantee that those patients will be able to contact their primary care providers immediately, which is a cause of anxiety for those patients. Secondly, patients become distressed while waiting to see if they would be able to retrieve a referral, which creates a negative atmosphere in the waiting room. Finally, some patients may receive their referral after designated appointment times, which means that accommodating the patients on the same day could cause delays. These delays cause a ripple effect in the schedule, even affecting patients who had their referral.

There are two ways of addressing the problem presented by the Step 2A loophole. The first would be to find some way to significantly expedite the process that is used to obtain referrals from primary care providers. This procedure would ensure that patients who arrive without referrals are not inconvenienced. Second, patients who arrive without their referrals would not be accommodated by the eye care center on the same day. These potential solutions will be pursued further in the appropriate sections below, particularly in the consideration of alternatives. Though, it is worth noting that the diagram above already identifies the key problem facing the front desk of the eye care center. That problem consists primarily of what should be done with patients who arrive for appointments at the center without a referral.

Lewin’s model. Lewin conceived of the status quo within an organization as an array of forces within a field that is frozen into place (Hussain et al., 2016). This means that to produce a change in the organization, it would be necessary to unfreeze those forces by creating imbalance, such as the implementation of a change initiative. Then, the final phase of the change would be to create a new status quo to stabilize the organization for future endeavors.

Thus, the diagram above is reflective of the current status quo. The diagram reveals that the primary performance gap is the processing of patients who arrive at the eye care center without a referral. The current status quo involves having the patients wait while they contact their physicians for faxed referrals, which is unsatisfactory to the patient and to the front desk workers at the eye care center. Moreover, if the patients do not receive the referrals by their scheduled appointment times, then they need to be seen later when other appointments have already been booked. In addition, the decline in patient satisfaction scores are now affecting the organization. Thus, it would be necessary to redesign the current organizational arrangement.

The first step toward doing this would consist of presenting the nature and scope of the problem to the head ophthalmologist. At present, the front desk has been trying to address the issue on their own without involving higher leadership, but this has proven to be an inadequate response to the problem at hand. To address the current array of forces, input from leadership is required. Moreover, depending on the resolution may impact the reputation of the eye care center and the number of patients that are treated by the center. This means that it is important to ensure that the organizational change has buy-in from leadership, including the head ophthalmologist.

The primary challenge to changing patient processing by the front desk is inertia. That is, although the current situation is chaotic and undesirable, it is nevertheless the way that things have been done within the organization. Despite this performance gap, the eye care center has been successful. Inertia also indicates that there is no sense of urgency to make changes within the organization. This is especially the case given that it is primarily only the front desk that thus far is even aware that the problem exists or that it is as severe as it is. Until the problem is brought to the attention of leaders within the organization, the current inertia will continue.

A major force that is pushing change, are that patient satisfaction scores have been dropping within the eye care center. This is a serious problem because patient satisfaction is a metric that is used when calculating insurance reimbursements to healthcare facilities (Lindsay, 2017). This is an objective problem that is confronting the eye care center, and it is not something that can be indefinitely ignored. Professionals within the center are generally aware that this is the problem, but they have not yet developed a clear framework that links the drop in patient satisfaction scores to the inefficient process of serving patients without referrals. Therefore, the purpose of the present project is to outline the nature of the problem at the eye care center. In other words, this document itself could help leaders within the organization become aware of the seriousness of the problem, which in turn will contribute as a force in favor of unfreezing the status quo and producing change.

Guided Performance Improvement

To summarize, the identified performance gap consists of inadequately addressing the patients who arrive to the eye care center without a referral. When this occurs, the patient is given the choice of either leaving, scheduling a new appointment, or attempting to contact their physicians for a faxed referral. The main gap emerges with patients who do not have a referral but decide to stay. These patients are often anxious or agitated while trying to contact their physicians. In turn, they generate an atmosphere of disorder within the waiting room and are generally upset no matter the resolution. This sometimes causes delays for other patients as well insofar as their designated appointment time passes while they are trying to contact their physicians and get their paperwork in order.

This problem happens quite often. As Brondani et al. (2016) highlighted, patients often know very little about the referral process and communication between healthcare providers is essential during the referral process. In general, patients who come to the regional eye care center without a referral are not aware that a referral is required, or alternatively they believe that their physician already sent the referral to the eye care center. Therefore patients tend to become upset when they realize they need a referral. When this occurs, patients tend to experience a great deal of confusion because they do not know what this means, nor do they know what to do about it. As a result, the front desk staff must dedicate additional time to contact their primary care provider to acquire a referral so that the appointment can proceed.

The identified performance gap happens primarily because of two reasons. The first is that there is no process in place to ensure that the patients’ referrals are in order before they even arrive at the eye care center. In principle, this problem could be addressed by having a referral on the books as a prerequisite for even making an appointment in the first place. It could also be addressed through communication processes that help inform the patients regarding the importance of having their referrals in order prior to arriving at their appointments.

The second reason is that the front desk workers at the selected eye care center are committed to helping patients who arrive without referrals, but they do not have a clear process for doing this that actually makes those patients happy and does not disrupt the broader operations of the center. In principle, the front desk workers could either turn away all patients who arrive without referrals, or they could develop a more effective process for managing patients who arrive without referrals. The problem at the present time is that the front desk workers are trying to help the patients without referrals while also at the same time not having an effective process in place for doing so.

Fishbone Analysis

When using the Ishikawa fishbone tool, the Centers for Medicare and Medicaid Services (2019) recommended using the following four categories to identify the root causes of a problem: equipment/supplies, rules/policies/procedures, environment, and staff/people. The f table summarizes how these categories are applicable to the performance gap that has been identified for the purposes of the present project.

Table 1

Table Title Needed ---- Style and contents of this table should be re-formatted.

All these factors contribute to the problematic outcome of decreased patient satisfaction at the regional eye care center. The environment appears to be the least serious factor. However, it should be noted that subpar experiences of patients who have referrals may be due to the leniency with which patients without referrals are treated by the front desk. Consequently, this is an unintended consequence of disrupting scheduled appointments, which then affects all patients within the clinic, including the ones who had a referral.

Next, we focus on equipment/supplies because they could limit changes made to the current process. For example, assessing whether the eye care center has the equipment/supplies necessary to ensure that electronic referrals are securely transmitted to the before the patients can make an appointment. Likewise, it is unclear whether the eye care center has the equipment/supplies necessary to upgrade from a fax machine to scanned e-mails for referrals. These logistical considerations could inform solutions for the identified performance gap.

Finally, staff/people are an important category that is reflective of the human resources available to the eye care center. In addition, staff/people are essential resources that may be re-deployed to effectively address the problem. Specifically, an evaluation is needed on how to engage with eye care center leaders and the head ophthalmologist to address the problems that are being confronted by the front desk workers.

STEP 1

Patient arrives to the RECC for a scheduled appointment either, by HMO provided transportation or alone.

STEP 1A

Patients are not registered or seen without a referral

Step 2

Patients that chooses not to contact their doctor or, unable to get one be faxed may reschedule or, they leave.

STEP 3

The RECC staff has recieved the referral.

Patients are registratered into the healthcare database.

STEP 4

Patient wait times vary upon amount of those recieving referrals post-appoinment schedule.

STEP 5

Patients recieve follow-up information, and leave the RECC with their mode of transportation.

Step 2A

Patients able to obtain a PCP referral via fax or, brought one to the appointment move on to Step 3

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