Redefining Access to Care at Texas Children’s Hospital

Added on Sep 10, 2020

Redefining Access to Care at Texas Children’s Hospital
By Lauren Keeley

Texas Children’s Hospital (TCH) in Houston revolutionized patient and family access to its ambulatory specialty care clinics by launching an “Access Initiative” that focuses on capacity management, appointment utilization, and the patient-scheduling experience.

The largest pediatric hospital in the United States, TCH has more than 40 specialty services and a patient population representing all 50 states and more than 70 countries. Although patient experience feedback was widely favorable, the organization started to notice an increase in demand for services, leading to extended wait times for families to get in for outpatient specialty appointments. At the same time, however, almost 20% of total TCH clinic appointments were going unfilled, and an additional 300,000 appointments were being canceled annually. Leaders realized they needed to act if they wanted to maintain quality standards and care continuity for their 3.4 million patients.

The Access Initiative was led by executive co-chairs from Operations, Revenue Cycle, and Physician Leadership, including Carrie Rys, assistant vice president of the Department of Pediatrics. Additionally, Grace Karon, assistant director of Business Operations & Strategic Planning, spearheaded a series of targeted workgroups that were led by multidisciplinary teams and were supported by a systemwide task force composed of clinical and administrative leadership. All team members had the collective goal of advancing a culture of “customer obsession” characterized by standardized processes, patient engagement, and robust, modern technology to optimize patient and family access to care. The team partnered closely with Press Ganey to understand what their surveys were telling them and worked to build the Access Initiative from there.

“We want our patients and families to engage with us in the ways that they want to. Often, that meant on their own time through a digital portal as opposed to having to call into central scheduling to make an appointment, or having the option to fill out questionnaires and make copayments ahead of time,” said Karon.

In the spirit of innovation, TCH has successfully rolled out 72-hour flips (automated functionality to expand unused subspecialty appointments into general appointment types for that service to offer broader availability), online scheduling, online PreCheck-In, an algorithm used to predict and visualize availability in exam rooms to maximize space utilization, telemedicine offerings, text reminders for upcoming appointments, and a no-show predictive modeling tool.

From 2017 to 2020, these changes have culminated in the following outcomes:

  • 26% completed appointment growth
  • 53,000 net new appointments added from standardized provider templates
  • 11,000 annual reduction in patient no-shows due to text message reconfiguration
  • 72% patient portal activation
  • 200,000 appointments utilizing PreCheck-In during the first year of the initiative
  • 55,000+ appointments scheduled online
Additionally, since TCH began implementing a patient-centered online scheduling portal, its Press Ganey top-box score for “Ease of Scheduling” has increased from 57% to 72%.

An early focus on one of these Access Initiative elements was particularly useful this past March.

“We’d been having ongoing dialogue about telemedicine with our clinical leaders about a year before the COVID-19 pandemic hit,” said Rys. “We knew it was not going to be one-size-fits-all, so we started work to tailor the telemedicine programming to each of the specialty practices.” These preemptive conversations, along with a digital platform vendor and training and patient education materials already in place, constituted a tentative road map into the unknown terrain of pandemic telehealth.

In the span of a few weeks, TCH went from launching one specialty with one provider pilot per month to launching all 40 specialties at once for thousands of providers. Telemedicine appointments increased from 14 per week to 12,000 per week in April. Karon attributes the success of these strides to frequent communication, willingness to embrace standardization, and finding simple solutions to complex problems.

Along with the medical director and manager of TCH’s telehealth program, Karon and the eHealth leadership team hosted “office hour” phone calls twice a day to respond to physicians’ and operational leaders’ questions, concerns, and positive feedback about the program. “From the end of March and into early April, I was on the phone about 14 hours a day,” Karon recalled.

Meanwhile, at the executive level, Rys was having daily meetings with clinical leaders in all subspecialty areas regarding telemedicine training, processes, and next steps on the road map. Coupled with updates from Karon, the eHealth leadership team, and TCH’s medical director of telemedicine, Rys would provide regular reports on the path forward to physician chiefs, who would in turn granulate the messaging down to their employees.

Once clinicians were comfortable with utilizing the telemedicine program, the task force focused on adapting the new pandemic care model to mirror the additional nuances around patient experience, such as scheduling. With the development of the Access Initiative, patients could use the online scheduling platform to schedule in-person appointments at their convenience. The new feature also stimulated return in value and resources in the system since no one was needed to answer the phone, Rys noted.

“We are in the process of setting up this technology for our telemedicine program,” said Rys. “The telemedicine appointment itself—which involved teaching clinicians how to conduct them and communicating to patients about how to access them—was one thing, but the administrative aspects of telemedicine are just as integral to creating a sustainable and successful telehealth model.”

The team is also busy filling some of the access gaps caused by the pandemic where telehealth cannot. TCH began a “Patient Express Service,” where patients and their families can drive through the ambulance bay area of the hospital for certain dermatology, pulmonary, and ophthalmology services that require in-person visits.

“Those slots went immediately,” said Karon. “From the time the patient pulls up to when they leave is about seven minutes, and they don’t even need to get out of their car. Sure, the way we deliver care looks different, but all of our efforts are still aimed at optimizing the patient experience and preserving continuity.”

Other elements of the Access Initiative have translated well into the COVID era. PreCheck-In minimizes in-person contact in the clinics and maximizes opportunity for social distancing, while growth in patient portal activation has made it easier to communicate transparently about the health system’s COVID-19 precautions, both assuaging fears and boosting trust.

In addition to meeting patients’ needs during the pandemic, building on the blocks of the Access Initiative has proven critical to the organization’s financial recovery. Without the ability to rapidly deploy telehealth in such a short period of time, large volumes of revenue would have been completely lost, Rys emphasized. In fact, while many organizations have shut down across the country from the financial impacts of the virus, some service lines at TCH are going to hit and even exceed their fiscal year goals for outpatient volume.

Early telemedicine survey outcomes seem equally promising, with many revealing comparable scores to those of in-person appointments, sometimes even surpassing them. The Access Initiative task force relies heavily on Press Ganey metrics to understand how receptive their customers are to new care delivery models, from telemedicine to drive-through ambulatory care. TCH leaders know that the past six months will change the way the organization delivers care forever, and they plan to keep patient offerings like telemedicine as a permanent component of their clinic model.

“From the early phases of the Access Initiative to our telemedicine program, our entire journey since 2017 has been about optimizing the patient experience,” Rys concluded. “The pandemic hasn’t altered this priority. It is at the forefront of everything we do, and it will continue to be.”