Families are knocking … open the door

December 11, 2017 | (31) Comments

One of the most frequent calls I get is from a concerned parent asking for my assistance to get an appointment for their child. On August 1, I held a meeting to discuss patient access and scheduling at Texas Children’s. I heard from each member of my leadership team and was advised that they receive calls for assistance every day. Did you know that we have nearly 100 distinctive sites that schedule patients and approximately 600 FTEs dedicated to this extremely decentralized process? This issue is extremely widespread across our system and it isn’t just A problem at Texas Children’s – it is THE problem at Texas Children’s.

I appointed Dr. Larry Hollier, Associate Surgeon-In-Chief and Richelle Fleischer, Senior Vice President of Revenue Cycle to co-chair a task force to study and make recommendations on how we can significantly enhance the patient scheduling process throughout the Texas Children’s enterprise. That multi-disciplinary task force has been hard at work, and I want to thank them, our nursing and medical staff leadership, and our In-Chiefs for all of their support and hard work. In addition, I know you are all aware that I have made access and patient scheduling a goal for the organization this year.

I’d like to share the thoughts from the mother of one of our Texas Children’s patients. She has a chronically ill child and every time she wants to get an appointment for her child within the Texas Children’s system, she takes a deep breath, says a prayer for her own patience and for that of whomever might be at the other end of the phone at Texas Children’s. She mentally prepares “to go to war.”

This is exactly what many of our families face when they attempt to get their children here to receive the care they need. And those words – “go to war” – those really are the words we heard from a frustrated, yet determined mom simply seeking the best for her child. Sadly, she is not alone. In a recent patient access survey, “frustrated” was the word families most frequently used to describe our scheduling process. Should it be that hard? Should a family already stressed by a health issue be further challenged by our system? No, it should not be that hard.

We are so much better than this, and we can do better. We pride ourselves on being the best at what we do and providing exceptional care. But if our expertise is locked behind a maze of limited availability and complicated processes that vary from service to service, we end up denying care to those who need us most. We can work smarter and more efficiently to do the most basic thing our patients and their families expect of us – we can open the door to our system and make it easier to get inside.

Fortunately for us, we already have the tools and technology in place to more than meet our patient families’ needs. What’s actually more critical to effect the changes we need is a shift in the way we think and a willingness to move out of our comfort zones and to do what’s necessary to make getting here easier for our families. Truly caring for our patients means being attentive to every element of their experience with us. In this case, it means we must change the way we do some things.

A few weeks ago, I emailed you about our FY2018 goals. As an organization, we are focusing on four priorities: Access, Care Coordination, Quality and Finances. In a few weeks, we will be making some changes specifically targeting the access challenges. Although we have leaders working diligently on the issue of access daily, I want everyone at Texas Children’s thinking about this. What can you do to help families get into our door? No one knows our system as well as you do, so when an idea hits you, I want to know … leave me a note below.

Demand for our care and services is ever increasing. The wisest thing we can do to ensure the health and future of Texas Children’s is to maintain the respect and reputation we have earned. Our goal is to exceed our families’ expectations. And being the one amazing team we are, I know we can do this. We must.

31 Responses to “Families are knocking … open the door”

  1. Alma Martinez

    Thank you Mr. Wallace for your attention to this matter on behalf of our patients and families. I have heard so many times from parents that it is an absolute nightmare to navigate our system. – “We are the care coordinators for our children”. I’m certain that together we will improve “ACCESS” for our families. I’m also grateful that our families have had an opportunity to tell us what their experiences have been like and what we need to work on – after all they are our #1 customers – without them we wouldn’t exist.

  2. Deedy Breaux

    I agree! Due to the large volume of kiddo’s that need our services, I think this will be the continuing problem of the future as we grow ever larger. As a parent of a former patient
    of Texas Children’s Hospital, I know personally the anxiety induced when you are not able to schedule what you need for your child quickly.

    Now as a Nurse, I am glad to take part with My Own Dept. of Pediatric Radiology. We use Pre-call nurses to work with the Radiology Scanner Coordinator’s and Scheduling to expedite Cardiac Clearance, and other health issues to ensure each patient is scheduled appropriately, as quickly as possible, for those needing Anesthesia or special arrangements for their visit.

    Those needs can range from special medical care for the fragile child, All forms of translation services at the ready for the parents, or simply a Child Life Specialist to be available to help our frequent visitors have a better experience. We all work very hard together, and at times can be quite challenged by the number of patients needing these services every day. But we are all proud to be a part of this team striving for excellence that is expected from those visiting Texas Children’s Hospital.

  3. Jennifer Scypion

    Hello Mr. Wallace. I take the story about the patient family member to heart. Although I work in the Finance department, advocacy is my passion. The “Go to war” comment she stated is when speaking with your team is a battle I have done on numerous occasions growing up in the medical field taking care of my mother who was very sickly. As I work in the medical field, as I take Disney trips, and as I walk through stores I look for the details that make an experience great on a patient or a consumer. What makes the good experience verses the very good? It is the “Wow” factor that makes the difference. The attention to detail that someone has over your situation that makes you stand out amongst the rest. I know you will have many ideas sent to you. I know that many will be great but may cost or may require man power we may not have. The fact that we are brainstorming on changing this means we are already in the right step. Because advocacy is so important to and we have those patients that are frequent long term fliers because of their level of care, I am going to suggest these patients accounts being flagged to have their own Personal advocate or what I would call “Family agent”. There would be a group of agents within this team that would handle many of the flags for repeat appointments or testing (which we would have a criteria list) that could be distributed by treatment location or by Alpha. In my list of patients I would speak set up appointments on behalf of the parent for the child within slots that are blocked off specifically for these types of patents. As a team we would work through these slots together on the back end that would allow for us to collaborate with the other teams as well let us do the advocating for the parent. When you are constantly having to “fight” for your child plan of care, to have someone else pick up your slack and “fight” for you builds a feeling of relief many caregivers do not get the option of experiencing. I look at companies like State farm where you have an agent that knows your family needs. I look at the “My HEB” saying and how it makes the connection more intimate. I would have loved for a person to “fight” for me growing up taking care of my mother. I know that this is very complex what I am suggesting but it is what makes us stand different from anyone else. It would be a signature move on behalf of TCH “Family Agents: Where we advocate for the advocate”

  4. Alene Whitesides

    I hear from some of our members of a waiting list for outpatient therapy services (PT/OT/ST) and behavioral health providers. If Texas Children’s can add some more providers in this area there is a demand out there!

  5. Bonnie Magliaro

    When patients are in our facilities as an inpatient and we know that they will need to follow-up with an appointment in one or several of our providers offices we should find out the patient/family’s availability and make that appointment or appointments for them BEFORE they are discharged. That is true Care Coordination and will impact ACCESS. We know best how to navigate our system and this would also foster transparency throughout the system on just how hard it is to get those appointments and to try to coordinate them happening on the same day. This practice would helps us uncover if there are commonalities in patients requiring follow-up appointments in multiple specialties that are commonly required of various diagnoses but that do not operate on their office hours on the same days making it impossible for families to schedule them on the same day.

    • Nancy Glass

      I think we need to be more thoughtful about which appointments actually NEED to be made. A child discharged from TCH doesn’t necessarily need to see every specialist that has touched the child, especially when many problems are stable or have been resolved. Many of these visits are “just because,” not because something needs to be done. In my experience, many families can’t even TELL you why they were asked to go back to “X” clinic. How about checking in with the patients FIRST before scheduling multiple appointments?

  6. George Miller

    Even though I work in the Food Service Dept and have studied Medical Office Management. Review your most busiest departments/ locations and prioritize team, meaning making some adjustments. Which can include putting more FTE’s out on the floor to get things moving. Look at some of things such as: How often does the patient have to come and visit, does the guardian make the appointment right then or later on. I would say get the patient on some kind of a cycle on their visits.

  7. Pamala Pennington

    I am employed in the GI & Endo/Diabetes clinics. I have noticed that people have said to hire more doctors. That is an option, but if we have more doctors and not enough room to accommodate the doctors, how would that work? My suggestion would be to change the doctor’s templates every few months to accommodate more new patients since this is usually where the problem lies. There are usually more established slots available and not enough new patient slots. Of course, if they have a need to return, they should make their future appointment before leaving the clinic if the schedule is open for the time that the doctor has suggested.

  8. Roxana Santaella, PT

    It is very unfortunate for our families to go through this experience. It is extremely frustrating for anyone. Here at the Woodlands, we are trying really hard to get our kiddos in and get them therapy services that we need. We are new and growing and will continue to grow and flourish since our care is only the best!

  9. Bonnie Viada RN

    I have great news! My granddaughter was at the Woodlands Hospital having an x-ray done. She was sent by her PCP, who is a TCH provider. The service was exceptional as my daughter was able to see Dr. Kushare in ortho shortly after the x-ray was done. The ortho team fit her into the schedule in a moments notice. She was cared for with the best staff and felt very happy and also comfortable while here. I can’t thank you enough and am blessed to work at this great hospital. Very proud!

  10. Lance Langland

    I appreciate the emphasis on access, as our sports medicine team at the medical center is constantly working with families and our scheduling staff to try to accommodate their needs/schedules. Our staff understands how important their services are and the potential that we have to make a positive difference in the lives of the kids that we serve. Our greatest hurdle is the limited amount of space that we currently have for sports medicine at the medical center. Our potential to increase access for our patients could be greatly improved if we had a larger facility that would allow our therapists the freedom of overbooking at the key/critical times of the day. With recurring weekly visits over several weeks to months depending on the injury, our patients/families need to be able to access our therapists before and after school. With limited space being such a huge factor for us, we currently do not have the capacity to over book during these key times because it would create significant safety issues due to overcrowding.

  11. In my previous role, as a social worker, I spent a lot of my time helping our chronically ill patients get into various clinics. I know the system and have contacts to assist me and it was still difficult. Our families have so much on their minds, navigating health care should not be another “thing” on their plate or feel they need to “go to war” with us just to get their child the care they need.
    As we look at where health care is going, I think ease of access is extremely important for the future of our organization. I know when I need to make an appointment for my child, online scheduling, limited wait time and the team listening and addressing my concerns are the things most important to me. We have the resources, talent and determination to ensure all of our families receive the best care in a timely manner.

  12. Amy Magruder

    I think it might be possible to run some walk in clinics on designated days. Our service has to have physician orders for Medicaid and CHIP patients, so those would have to be in place ahead of time. If people want to come in a risk a bit of a wait time, they would be able to see a provider without waiting for an appointment.

  13. I am so happy to hear that their is something being done to better the patient experience when scheduling. I work in the C4 department and I hear this all the time as well, and for me is a joy when I’m able to help out a parent and hear the relief in their voice when we have accomplished to fit their child in with the specialist in a reasonable time frame.

  14. Jennifer Holland

    Improving the scheduling experience, prioritizing urgency of patient visits, and incorporating a central wait list into the scheduling process would improve access in our department. Currently, if a patient cancels an appointment with me tomorrow afternoon, that open appointment may be given to the next patient who calls asking for a hearing test. Just by luck one person may wait 24 hours for their visit while another waits 3 months. It would be helpful to create a central system that would allow patients who requested to be on a wait list have access to the slots opened up due to cancellations.

  15. Mr. Wallace: Thank you for making this a priority. It is very hard to compete when patients have a choice and have such a hard time just getting in the door. Central scheduling needs to be as optimized as much as possible because of how much we rely on it. At one point in the not so distant past, the work force was so depleted in central scheduling that there was a significant call-drop rate, something that should never be allowed in the future. Physician providers in some departments are plentiful, but the non-physician providers (audiologists, speech therapists, physical therapists, social workers, etc.) that physician providers rely on are not as plentiful. Providers may want to also simplify how RelateCare is structured for their templates. I believe our administrators need a better understanding about what happens at the most fundamental and basic levels clinically: round with physician-liaisons to see what the barriers are to getting patients in the door, be a “mock” patient on the phone with central scheduling to experience what patients experience, simplify the process on the phone with central scheduling, market MyChart better and allow making appointments via the internet like our competitors do. Access and central scheduling give the initial first impression of TCH and we all want to make a great first impression.

  16. Robert Stowe

    An easy excuse will be to place the burden on physicians to “do more with less” by increasing clinic hours, decreasing time per patient visit, or adding clinic days at the expense of scholarly and academic activities and pursuits that are and should be hallmarks of the Texas Children’s leadership in the world of academic pediatric medicine. Such proposed solutions would only contribute to physician burnout factors while necessitating increased clinical support needs (e.g. nurses, medical assistants, etc).

    Outpatient clinical spaces are getting sparse at Main Campus and physicians already have full schedules and we haven’t even opened up Legacy Tower, which will increase inpatient volumes and need for prompt outpatient specialist follow-up. Effective solutions to decrease and limit no-shows in clinic are needed without simply overbooking clinic slots or putting patients into clinic slots that do not maximize the physician-patient experience (e.g. a patient complaining of muscle weakness is seen by a physician who specializes in epilepsy rather than a general neurologist or neuromuscular specialist). Walk-in clinics are a consideration but again these need to be effectively staffed and regulated (i.e. the 1 or 2 staffing physician in a specialty walk-in clinic cannot reasonably see 20 new patients in a half-day). Limited numbers of add-on patients willing to wait may be a consideration for some clinical pools that experience high no-show rates; the burden should not fall to resident/fellow clinics at the expense of effective training.

    The goal of improved access is something all physicians wish to see and realize, but the reality returns to back to a need of increased clinical space, more physicians, and more support staff, all of which requires significant capital investment.

  17. Hi Mr. Wallace,
    As a parent of a child at TCH (heart center) I have to say MYCHART Is the best app invented! It is extremely beneficial and a great way to communicate with your child’s doctor! Especially, to book appointments without having to pick up the phone and be on hold. I just wish that all departments were as compliant at using it as my son’s pediatrician’s office (TCPA-Kirby)! My sons pediatrician is amazing at answering my questions in a timely matter.
    Smart phones and applications have become the new trend! There’s an app for anything now a days!
    I’ve found it extremely convenient to schedule appointments via my chart! Perhaps training the staff, or advertising appointment booking using my chart can improve some of the time hold for appointment booking an lead parents to booking appointments using the app.

  18. Sarah Maytum

    There are so many great ideas in the comments above- it is always amazing what we can accomplish when we all work together to solve a problem. Our patients and families deserve easy processes and quick access to our expert providers across the system. Imagine their relief when they get their questions answered and concerns addressed in three days instead of three weeks or three months. Thanks to everyone who is working so hard to make access better for our families!

  19. Deborah Nisbet

    We must always be looking towards eliminating the barriers to success. Having a family member with medical needs is already a stressful situation and as health care team member, which is why we all are here, we should be aware of that factor and work towards easing the burden on their care givers shoulders. I am constantly amazed at the great work that Texas Children’s does and the services we provide. I’ve walked in this mother’s shoes, it just shouldn’t be that difficult when we’re just a phone call away.

  20. Roula Zoghbi Smith

    It is so exciting to see the comments above — it affirms that we all want to solve this for our patients and families! Many of the suggestions above are solutions we are exploring and pursuing within our task force. Thank you for your leadership and charging us as one amazing team to tackle this head on!

  21. Geneva Maya

    It is a huge problem. But I think we just need more docs at our clinic to accommodate the need. We also need more patient rooms as well. The schedule at the TCP I work at is always full by 8:30/9am. Especially during this season when all children get ill. I don’t think there is a simple solution.

  22. a physiian

    While top down solutions are tempting, I think it’s important to remember that each clinic in the TCP system has its own challenges. Some clinics are in such demand that simply adding more schedulers will not improve access because the providers are already booked (or overbooked) and struggling to provide access to established patients. As one physician said, it’s tempting to ask physicians to “do more with less.” This really needs to be looked at carefully. Burnout is real, and having providers see more patients, particularly more new patients, is a recipe for burnout. New patients are very time consuming, much more than established, and this needs to be factored in to scheduling changes. Decreasing no show rates is something to look into also — this problem varies between clinics and can be quite significant. All in all, I think that any solution needs to factor in not just patient satisfaction but quality of work/satisfaction for physicians and all involved in patient care from check-in to check-out. If employees are happy, they can do a much better job serving families in a pleasant way.

  23. Sara Montenegro

    I’m very excited about this effort, and all of the great ideas coming from across the system to help support this improvement effort. I know with the power of our system working together, we can solve this. Our patients deserve this focus and attention, and I’m looking forward to this.

  24. Texas Children’s is feeling the impact of the exploding Houston population. “Doing more with the same (or less)” just isn’t safe, and not going to get us where we want to be with regards to excellent patient care and patient satisfaction. I concur with Ron and Robert Stowe’s comments and suggestions.

  25. Sandeep Dilwali

    It may help to have a group of staff from various departments, not just in leadership positions, get together on a weekly or monthly basis to discuss this issue, try to find out what are the underlying reasons leading to this, however trivial and obvious they may seem to be, come up with ideas for addressing these issues, and present their plan to leadesghip to solve this. Based on approval from leadership, implement possible changes, one at a time, to identify what works and what does not. Review it after a month of making every change, and keep discussing as a group what all needs to be done. The “Quality Circle” approach may be effective.

  26. Annette Greene

    I have been here at The Center for Children and Women – Southwest for just shy of 3 years. In this short time, I’ve watched our waitlist for Behavioral Health services go from non-existent in 2015 to a minimum of one month (and sometimes two months) wait, currently! With the awareness and less stereotypical opinions of behavioral health issues, I think it’s wonderful that so many people are reaching out for this help for themselves and their children. But it truly saddens me when I have to tell a parent or patient in dire need that they’ll have to wait over a month for an initial appointment – and then wait another month (or more) to begin regular weekly therapy! This level of growth is a testament to our quality of care and I don’t want it to become tainted by a lack of ACCESS. We have a track record of being a top-rated health care provider for many years and it’s something that I’ve always felt proud about. For our Center, what we need is more staff to meet this demanding need.

  27. Eric Wilson

    Great blog and comments. Yes, this is what we should be focused on. In my 10 years of calling on referring physicians, this has been the top feedback we have received and reported. I’m very happy that this is a company-wide objective.

  28. Janet Winebar

    I’m very excited about this effort, and all of the great ideas coming from across the system to help support this improvement effort. I am confident that we can come together as one amazing team and change this cause of frustration into one of our strengths!

  29. Another point of access is that not all surgery clinics afford the patients the opportunity to schedule their surgery on the same day that surgery is recommended if parents desire to do so. This opportunity would increase efficiency and streamline surgery scheduling.

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