DMAIC Project: Improving Nurses' Assessment of Care Needs Over the Phone

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Baseline (Define)

Improving the process of nurses' assessment of care needs over the phone. The client is the patient calling the health centre for a care assessment. The process needed to be improved for a number of reasons. The telephone assessment of care needs was often not completed. In such cases, the client was left waiting for the situation to be resolved and the call nurse would call the client back later. In addition, the time of all professionals was not used and the client was unnecessarily referred to a doctor or to the emergency room. This also led to an imbalance whereby no appointments were available for the client.

Process performance at the beginning (Measure)

Process performance at the beginning: 11.98% of calls have not been completed, leaving the matter unresolved in terms of the assessment of the need for care. This significantly slows down the client's access to care/resolution of the situation. the percentage of missed calls is too high. The target was set at less than 5% of missed calls.

Improvement measures (Analyze & Improve)

Root causes: there are no root causes for call nurses carrying out care needs assessments:

1. a consultant doctor to consult in the client's situation (e.g. where to refer the client in case of doubt, asking the client for lab results, renewing prescriptions, resolving the client's situation through pre-counselling and home care instructions)
2. comprehensive and clear guidance at the workstations on what services are available in the social and health centre

Solutions: Re-allocation of resources:

1. One of the doctors acts as a consultant doctor, while the other doctors get some peace at work (less extra interruptions and questioning).
2. The call nurses receive direct consultation support from the doctor to resolve the client's situation (for the assessment of care needs by telephone).
3. Build clear guidelines at the point of contact for call nurses on what other services are available in the social services centre.

Results (Control)

Results: The performance of the improved process is -> 4.47% of calls were not resolved and left unanswered. Before the improvement, the process performance was 11.98% of calls were not resolved and abandoned.

Monitoring results and continuous improvement:

• Consultant physician book key issues to monitor: whether there is too much / too little and what is being consulted on, who is consulting (nurses / doctors) and what is the optimal resource requirement for a daily consultant physician.
• "Errors": doctors report to the emergency department if they receive clients who should not have been referred to the emergency department, but to another health professional.
• Monthly monitoring of data from patient information systems: queues to emergency departments, queues for non-urgent medical appointments, access to treatment from first contact. In the longer term, the consultant-physician approach should result in a reduction in queues, particularly for doctors' non-urgent appointments, as clients are not diverted to the doctor "in vain", but other solutions are used effectively.

Continuous process improvement with employees based on results.

‍Thisproject was a training project that the participant did during the Black Belt training and received a Black Belt certificate at the end of the project.
If you are interested in learning how to improve processes using Lean and Six Sigma, and obtain a Blacc Belt certificate at the same time, check out the training at the link : Black Belt training.