In a world where we are all quickly adapting to the “new normal,” as a solo pediatrician, I have found inspiration from fellow solo and small practice pediatricians. Thank you to Jenn Gruen for sharing your telehealth process (excellent info on villagepedi.com), to Hiral Lavania for sharing the list of what is important to parents when coming to our offices, to Dr. Una (@drunachukwu) for all of the podcasts-so motivating , to Brandy McCray for the “patient experience” video on FB, to Sogol Pahlavan for sharing her social media tips, and to Katrina Skinner, for showing us the power we have if we “step up.”
A few weeks ago, Katie Schafer brought up a topic about “the future of the waiting room.” My office doesn’t have a waiting room, so it’s a topic I don’t have to dwell on, however, it did make me start thinking about all the possible ways the patient experience is going to change. So much focus has been on new expectations of staff, new workflows, etc. Little focus has been written from a family/patient point of view.
I have compiled a document, which attempts to go through a patient visit lifecycle, which starts with making an appt and ends with the completion of the visit. My personal goal is to expedite face-to-face time in the office, for those who require in-person office visits, and keep patients out of common areas. I’d love to hear others’ thoughts and ideas about improving the patient experience as we embrace the “new normal.”
Finally, a big congrats to all of those who have decided to open your own practices as a result of the pandemic. There is nothing better than being able to #beyourownboss
Thanks Robin for the shout out! As we move towards a re-open that will need to include sick patients beyond telehealth, I am grateful for small-group sourcing to see what everyone else is planning. One idea i am toying with is to have a morning telehealth “walk-in”, where we then decide on any necessary testing/in person exam that would be scheduled at a later time (ideally end of day after well visits done.) Would do all testing (strep, flu, covid) outside, then bring in for exam as needed w rooms then left to air/be cleaned overnight. Since sick kids won’t be going to school (no more quick strep test prior to school drop off) I am hoping there will be less push back on such a concept. What is everyone else thinking? We are too small to have one office or area of an office dedicated to sick visits, though do keep 2 rooms solely for infant well visits. We have been doing drive by vaccine visits w great success (actually have done this with flu shot visits for many years now), and will set up a small tent behind our building for the summer/nicer months to see sicks, but can’t do it year round in CT.
I think sick season is going to be very mild this summer. Unfortunately, our parking lot doesn’t lend itself to a tent. I have done car visits to check ears or listen to chests. I love your idea about “walk-in” telehealth. That could really free up the phone as well. Thankfully, we have payment parity laws for telemedicine. I’m hopeful that states who don’t change their tune quickly.
I had hoped to do telehealth walk-in visits, but have found that there are enough technical issues with doxy.me that it is hard to have a family “walk in” online. Most people have their cameras/microphones in privacy mode, so we have found that it is best to first send instructions to make sure those are enabled, then have a staff member call the patient and get them into the online waiting room at the appointment time.
Love the idea of telehealth walk-in visits. I would visualize it for us as patient calls early morning (we did have walk ins from 7:30 - 8:15 am), staff determines it’s an acute visit. I would then use the doximity app to text a patient for an immediate video call. This is still HIPPA compliant, free if you have the phone app. I was a test group for the video. Works great and often I like it better than the doxy.me. I can have my phone propped against my lap top, be talking to them, seeing them as I type into the EHR!
Thanks for the pdf. I took the bones and modified for my office. It seems I’ve been changing things daily to every other day and driving staff crazy. We were in a flow until the telemed wells follow up started trickling in the past 2 days to fill gaps in the schedule. Through everyone into a tizzy about flow. Hopefully, this will help.
Robin, thank you for the shout out! I agree with your train of thought. I have been wanting to resurrect our family advisory committee to explore this topic. We can predict what we think parents want but why not just ask them? Checkout surveys are also a great way to find out what parents are thinking.
Our new mantra is “Every Sick Visit Starts as a Telemedicine Visit” It is easier for the schedulers; it reduces free care given away through nurse triage; we have self-scheduling available which we prefer to “walk in” hours, and if we can keep someone out of the office and complete the visit remotely, that’s great. If they need to come in, we have already completed a portion of the visit (so limiting time in the office) and we have a plan for what will be needed.
We have two offices- one is dedicated to Well Visits (and non-contagious symptoms). The other office has been the “Sick” office since March 13, BUT, we just installed a wall (with a door) to split that office into two distinct, physically separate spaces and are in the process of converting our waiting room into temporary exam rooms. I wil try to add pictures!
We expect to be ready to see Well on one side and Sick on the other side in the next 2 weeks-- if this works, we think we would flip flop the two sides during the winter to create more capacity for sick visits and use the smaller, temporary side for Well Visits during that time.
That second door you see through the open door was just installed! It creates a separate space consisting of the “business office”, the waiting room, and the patient bathroom (which has a pass through window to the “dirty” lab). Voila! Instant Sick Office leaving the rest of the space as a Well Office with its own entrance.
@katski We are talking about using zoom for a family advisory meeting!
@robinmwarner In addition to the “Every SIck Visit Starts as a Telemedicine Visit” mantra, we are also leaning hard into the phrase “Contactless Culture,” Your list is a great exercise in thinking about all the “touches” a family has with the practice and then brainstorming how to transform each one into a contactless interaction when possible.
One thing that helped us pivot quickly to remote work environments- besides a cloud-based EMR and telemedicine- was a VOIP telephone system. It allows remote workers to make and receive calls as if they are at the office.
Other lifesavers have been remote check in ( our doors are actually locked and families can only enter after they have completed check in, which includes COVID risk screening) and the car as the waiting room.
Judy,
Would love to hear about what changes you make, what works, and what doesn’t. Every office has its own culture, but the sharing of ideas is what allows others to discover solutions they may not have thought of on their own.
Katrina,
Tell me more about your family advisory committee. How did you choose the members, or did you ask for volunteers? Do you have a good demographic cross-mix, where everyone has some representation? How often do you “meet,” and how have you traditionally met-in the office or online?You also mention a check-out survey. In the past, have these been paper handouts, or did they get an electronic survey to complete? In my desire to be as “contactless” as possible, I would rather do electronic.
Has anyone used one of the “free” online survey tools? I’m looking at sogosurvey right now.
Misha,
How have your employees liked working from home? Do they feel they are more productive? And, since you’re in Michigan, what are your plans once it gets colder? Is your staff going out to the car to escort the patient in, taking their temp in the car?
Robin
@robinmwarner I think it has been mixed One superstar receptionist, I think, would be happy to work from home forever going forward. I think for the rest of them the tradeoffs of no commute, flexibility, etc wear thin after awhile and people express missing the community of real interactions. I think that will become a factor.
We have definitely not thought through what will happen during a Michigan winter But, in our office that has its own parking lot and is a freestanding building, parents were already used to waiting in their car if they were coming in for particularly contagious symptoms for what we called the “Back Door” policy… so it may not be that hard to adapt.
I feel like we have been living so day by day with our planning horizon being “what does next week look like” that it has been really hard as we begin trying to think “what does next month look like, what does the summer look like, what will the fall, winter, next year look like”
@j.orton you are not alone in how hard it is to change… we have been making changes almost daily for 2 months and it takes so much communication and we feel like everyday no matter how much we think we have prepared, we are presented with a variable that we did not anticipate and then have to troubleshoot in the moment. Everyone gets stressed!
We use a combination of group text messaging (inside our EHR) and emails and phone calls to keep everyone as much in the loop of what is happening as possible. That seems to help!
Robin, we started this council in 2018 (I think), and it initially took place every 2-3 months in our conference room during lunch time. We provided lunch and $25 gas gift cards for their time and participation. The clinicians and staff nominated parents and grandparents for the council and we made an effort to select members who represented as many different aspects of our patient population as possible. We even added a teen to our council eventually.
Staff changes, a maternity leave, the holidays, and now COVID mean the council hasn’t met in a while, but when we were meeting, the feedback was great and we also tried to provide education for the members. We polled them at the start to find out topics they were interested in. We also used them as our focus group when considering changes to our workflow or offerings.
Not only was their feedback tremendously valuable and well worth the money invested, but they became wonderful advertisers for us in the community because they were able to get an even better idea of much thought and hard work we put into providing care for our patients and their families.
I highly recommend implementing a group like this, and talking about it makes me realize how important it is to get ours going again!
You’re welcome, Robin. I can’t wait to hear how those things go for you!
And sorry I didn’t specifically answer your question about surveys. We have always done a little slip of paper at checkout but since we are finding ways to make the check out desk part of our in room workflow, I am reworking that process, too. I would love to hear what you decide to use for an online survey.
Before COVID we had a scheduled side and a walk in clinic side. We are not allowing patients to walk in now to be seen, but they can call and be seen same day through telehealth. We decided to not allow patients to request a visit through the telehealth to ensure our wait times on telehealth weren’t long. Occasionally we do have a patient request through telehealth who didn’t call to make an appointment and if we can accommodate them at that time, we do, or we let them know there will be a wait and give them the option to schedule later that day. It was worked really well for us. If the patient needs an exam or swab, we give them a time to come to the clinic to be seen outside. The same providers working the walk in side are the ones now on telehealth and seeing patients outside. We have 2-3 providers each day in that clinic. We are in Texas and have a parking lot so we have this capability. We are now trying to figure out how to manage seeing patients outside in 90-100 degree weather though and in the rain. Let me know if you have any questions.
, to Brandy McCray for the “patient experience” video on FB, to Sogol Pahlavan for sharing her social media tips, and to Katrina Skinner, for showing us the power we have if we “step up.”
One superstar receptionist, I think, would be happy to work from home forever going forward. I think for the rest of them the tradeoffs of no commute, flexibility, etc wear thin after awhile and people express missing the community of real interactions. I think that will become a factor.
But, in our office that has its own parking lot and is a freestanding building, parents were already used to waiting in their car if they were coming in for particularly contagious symptoms for what we called the “Back Door” policy… so it may not be that hard to adapt.
