I believe that the overall organizational structure, which I have discussed in previous blog posts is the single greatest factor that can inform problem solving and leadership improvements within the clinic. From all of my interactions within the clinic, I would say that generally all employees understand, support, and strive to uphold the mission and vision of the organization as a whole. The organization aims to empower residents of the Shawnee neighborhood by providing holistic, quality healthcare to those in need. Employees of this organization are highly unified and motivated in terms of using their respective positions to contribute to this overarching goal. Thus, in terms of “heart” for the work to be done, their is a high level unity across the organization.
However, I would say that the most significant challenges to accomplishing this mission arises from organizational problems. In a very broad sense, the organization can be divided into two key departments: the administrative department and the clinical department.The division between the administrative and clinical departments is the area in which I have observed the most issues, as well as the area which I believe holds the greatest potential for improvements for the overall organization. One main team within the administrative department is the front office team. The front office team’s main responsibilities include scheduling appointments, answering phone calls, filing paperwork, processing insurance, and interacting with patients. Perhaps most notably, the front office communicates to the clinic when patients are checked in and ready to be triaged. This typically occurs via computer. The front office will switch a patient’s status to “ready” on a screen that the back also has access to. This lets the medical assistants know it is time to go get a patient for triage. However, just because the front office and the patient is ready to come back doesn’t mean that the back is ready for the patient to come back. Often, appointment times run over, providers have pretty packed schedules, a patient needs an additional test run, etc. Coupled with the fact that the clinic has been understaffed, this often leads to delays. The clinic just hired another doctor this week, so hopefully this helps more patients be seen. However, there is still significant communication issues between the front and the back that lead to a lot of tension between the two departments and a lot of waiting and frustration on the patient’s side.
There is not a clear, defined procedure for what happens when the clinic is extra busy and patients have been waiting for a long period of time. Both the front office and the back clinic have the same end goal: to care for patients in an effective and efficient manner. However, the front office is largely concerned with reducing wait times and getting patients to the back as fast as possible. The front office is the first group of individuals patients see and interact with face to face. As a result, they deal with a lot of the stress and complaints of patients as well. When this occurs, the front office will often call the back of the clinic and remind them that a certain patient is waiting and has been waiting to be triaged for “X” amount of time. Thus, the phones in the clinic will be ringing off the hook at the time when the clinic is the busiest and has the least amount of time to answer the phones. I have often heard medical assistants say they don’t have time to call pharmacies, triage patients, fill out paperwork, and run tests, while simultaneously answering calls telling them to push the providers to hurry up because their patients have been waiting for an extended amount of time. Moreover, people seem to be on different pages about whether calling, putting notifications on the computer screen, or sending the patient back seems be the best way to deal with the issue.
First, I think that the front office and the clinic need to have a meeting where they come to a clear consensus about what should occur in these situations. For example, instead of calling the back, the computer system could still be used and could be color coded. For example, a patients tab could be set as green when they are checked in and then the front office could switch the color of a patients tab to yellow or to red to indicate that a patient has been waiting for an extended or unacceptable amount of time and needs to be taken back ASAP. Coming to a consensus on procedure during these busy times will lessen the stress of the situation for both departments. Moreover, I think a single person in the front office and a single person in the clinic (for example: the head of the front office and the clinical coordinator) should be responsible for communicating procedural needs during these situations. Currently, anyone in the front office may call or approach anyone (a medical assistant, a nurse, a provider, etc.) about the issue. In these situations, often a provider who isn’t even seeing the patient in question or the wrong medical assistant will be notified and then have to pass that information along to the correct one. Instead, I think one individual from the front and one individual from the back should have clearly defined responsibilities to coordinate the action of these two departments. Improving leadership, strengthening oversight functions that increase and facilitate the collaboration of these distinct, yet intertwined teams within the organization has the potential to improve the appointment process, reduce wait times, bolster doctor’s morale, and ease tensions between the two areas of the clinic.