Abstract
In a private practice setting, systems theory terminology can be used to illustrate the process by which patients are treated, particularly in terms of organizing of scheduled appointments. One of the biggest problems in my current practice with the appointment-setting system is that the existing software is incredibly antiquated. This leads to many different inefficiencies, ranging from miscommunicated details about the patient’s condition to trouble with the actual scheduling of appointments themselves. Given this information, I would address the problem using systems theory to devise a more effective appointment-scheduling system. The desired outcome for the new system would be one that provides greater output, more positive outcomes, and reduced negative feedback. It is my utmost belief that this proposed resolution to the problem will uphold the organization’s mission and values, as well as improve the organizational culture and climate.
In a private practice setting, systems theory terminology can be used to illustrate the process by which patients are treated, particularly in terms of organizing of scheduled appointments. In an open system setting, “[a]n organization depends on its supporting environments for continued inputs to ensure its sustainability and processes these inputs through the recurring and patterned activities and interactions of individuals to yield outputs” (Meyer & O’Brien-Pallas 2010, p. 2830). As applied to a nursing and medical practice environment, the need for this continued input is paramount, as resources and personnel can become scarce. The input (e.g. the raw material the system will transform) consists of the information the client possesses, the energy and time of both nurse and patient, and the capacity of individual effort. The throughput (e.g. the process the system uses to turn that energy into a product) involves the actual process of communicating with the patient, gathering information from the patient and entering the appropriate data into appointment software. The output (e.g. the end product or service) is a fully-completed document that denotes when the patient is going to come in, what they are coming in for, etc. Cycles of events consist of each time an appointment is made and set by the nurse and patient. Negative feedback is the information about the effectiveness of the appointment process that should be used to improve the system – for example, they can consist of problems people have with the system, inaccuracies leading to tardiness or mistakes in treatment from misinformed physicians, and more (Meyer & O’Brien-Pallas, 2012).
One of the biggest problems in my current practice with the appointment-setting system is that the existing software is incredibly antiquated. This leads to many different inefficiencies, ranging from miscommunicated details about the patient’s condition to trouble with the actual scheduling of appointments themselves. Because of the nature of the software, there is a character limit on the details box when we type what the problem is with the patient; this leads to nurses using shorthand that confuses the physician, or cutting off important information regardless. Furthermore, there is a bit of an inefficient process by which the nurses prompt for information; as the patients do not necessarily know what to say, they may come in with a misunderstanding on the part of the nurses as to what is wrong. Also, the software frequently cuts from a calendar mode to an individual entry mode (required for new entries) and so it is difficult and time consuming to check what dates/times are available. To that end, there is problems with the input (external information is not being utilized or gathered in the right way), throughput (the energies of the nurses are misplaced and ill-used), and output (poor appointment notes for scheduling and diagnosis purposes). No formal negative feedback procedure is in place for this appointment-setting system apart from individual, informal nurse and patient appraisal.
Given this information, I would address the problem using systems theory to devise a more effective appointment-scheduling system. The desired outcome for the new system would be one that provides greater output, more positive outcomes, and reduced negative feedback. The ideal goal is to create a system that would permit a comprehensive approach to appointment setting and call-taking that would a) extract the maximum possible information from the patient about availability and purpose of appointment; b) find the most effective time that accurately lines up with the physician’s schedule; and c) convey the patient’s input regarding their condition accurately in the appointment entry to the physician, so they may effectively prepare for said appointment. This would increase functioning, make phone calls and in-person appointment scheduling more effective, and create a comprehensive and accurate database that would take less time to utilize (due to its streamlined process and less time wasted with errors).
The changes posited are as follows: research would be performed on sufficiently-improved database and spreadsheet software, and one would be selected that would meet the above criteria. There would be no character limit on the patient information box, so that nurses could type as much information as they need to permit greater understanding of the physician as to the concerns of the patient. Appointment scheduling would take place through an interface not unlike Google Calendar or other open source web-based patient record systems, with point-and-click appointment setting that would allow for easy access to other appointments and openings that would work for the patient (Syed-Mohamad, Ali & Mat-Husin, 2010). This would dramatically reduce the time it takes for nurses to switch back and forth between screens to check appointment availability on certain days. During calls to set appointments and establish the problem the physician would expect to handle, a standardized set of questions would be given to nurses to use in order to derive the most pertinent information from patients as possible (e.g. “Do you have any allergies?” “Have you or a family member ever had a history of ____?” etc.). All of these specific steps would serve to create a system that would provide the department with quick, accurate and informative appointment-scheduling that provides the physician with as much clear information as needed and fewer conflicts with scheduling. Ideally, there would also be an option to double check information before setting it as a concrete appointment, to increase accountability.
Once the appropriate software system is found, it would be slowly phased into normal nursing practice; nurses would be trained on the software outside of regular nursing practice until they are familiar with it, and then we would roll out the new system. Existing appointments would be reentered into the new system, and the appropriate workflow approach for answering a telephone call to set an appointment would be exercised. Relevant professional standards would be applied and adhered to, thus ensuring that our scheduling practices are at their highest efficiency.
After the system would be rolled out, we would allow for negative feedback in the form of nurse reports on errors in the system – keeping a log of errors made in the new system would allow us to track how well the system is doing, and to make further changes to procedure if need be. One possible system to be considered for quality control is the HIS-monitor instrument, which is a 41-question survey on the quality of information processing in computer-based nursing information systems (Ammenwerth et al., 2011). Furthermore, if there are redundant steps that are taking up too much time in the process, nurses would be encouraged to provide that feedback as well so chances could be made appropriately. The goal is to use our resources as effectively as possible, so anything that reduces nurse’s energy and effort while still providing equivalent output should be considered. Nurses who are most familiar (and proficient) with the appointment system will be placed on that duty to ensure effective outputs. While appointment scheduling calls do not relate directly to the maintenance of care and clinical outcomes expected of nurses in a systems approach (such as control/management of symptoms, prevention of complications, and more), they do relate indirectly to the physicians’ ability to prepare for the appointment, and may even lead to complications if mis-scheduled appointments delay treatment and diagnosis (Meyer & O’Brien-Pallas, 2012). To that end, it is absolutely vital that a systems approach ensure that the appointment setting system is as effective as possible.
It is my utmost belief that this proposed resolution to the problem will uphold the organization’s mission and values, as well as improve the organizational culture and climate. The mission statement of the organization involves providing earnest and effective care to as many patients as possible; by making as streamlined and accurate an appointment system as possible, we can serve more patients in a business day, and cut down on mistakes that take up valuable patient and physician time (as well as creates the risk for misdiagnosis and malpractice). Furthermore, this would vastly improve organizational culture and climate by creating an environment that allows us to do our jobs more quickly and effectively; we would spend less time fixing the mistakes of ourselves or others, and this would increase morale through allowing us to do our jobs more effectively. Patient satisfaction would be higher, which would also translate to more positive outcomes and workplace environments for the nurses and physicians of the practice. The ideal system would provide for a complete and efficient appointment scheduling system that would eliminate existing problems, and free up inputs such as nurse energy and time to be utilized in clinical practice.
References
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