It was like chipping away at a mountain.
Staff in the Health Records Department at Saskatoon’s three hospitals used to feel they were fighting a losing battle when it came to updating outpatient health records. Each day, they attempted to whittle down the backlog of paperwork, only to leave at the end of the day feeling as if they had failed.
Over the past two years, department staff has used improvement events to tackle the increasing backlog of outpatient filing paperwork.
“When we looked at our processes in depth, it was easy to see that we were over-processing by sorting and re-sorting reports over and over again,” says Kathy Braaten, Manager of Health Records and Clinical Information for Saskatoon Health Region. “We would sort not only by file number, but by date because we believed that was needed so others could find the reports. All of our health records sites in Saskatoon Health Region did this slightly differently, but the end result was that we touched those pieces of paper way too many times."
The first improvement event was held at Health Records at Saskatoon City Hospital. The event focused on streamlining processes in order to reduce the time between receiving patient information after a discharge, and the paperwork going into the patient’s file, and it was during that event that the group came up with a “first in, first out” process for the outpatient filing.
The Health Records department at Saskatoon City Hospital.
“Anything that came in was gathered in two-inch increments, and filed directly onto the patient charts, with those that came in first being filed first,” explains Braaten.
It was challenging at the beginning, she notes, but staff adapted, and soon it was easy to see the advantages to this system.
“Because of the way we do things now, we have eliminated the waste of sorting reports over and over again,” Braaten says. “It required a cultural change, because though we assumed that we needed to sort the reports in a specific way so people could find them easily, the extra steps added time, and the reports were still difficult to locate. We determined that when we changed the process.”
Another benefit to the new process has been gaining the knowledge of the resources needed to tackle the filing. Previously, Health Records had no way of measuring what came in and what was ultimately filed. But by using the two-inch increments and documenting the amount of time taken to process two inches of files, they now know what resources are required to complete the work.
“It really speaks to the old adage of what gets measured gets done,” says Braaten. “And with this system in place, we know how many staff we need to get today’s work done today, so it’s easier to determine what staffing levels are required.”
Another advantage is the visibility this system affords. Because of the measuring system, it’s easy to see how much work has been done, and what is left to be done.
The first improvement event at SCH was so successful the department replicated it at both St. Paul’s Hospital and Royal University Hospital.
“At each site we worked through some challenges specific to those sites; however, at the end of the day, we all have a system that has eliminated waste of extra sorting, and includes a first in, first out process that is visible and measurable,” says Braaten. “It didn’t seem possible, but every site has been able to manage to do today’s work today, which helps our staff feel a sense of accomplishment at the end of the day, as they are able to leave caught up on their work.”
These improvements mean that patient files are being updated with outpatient information in a very timely fashion, ready for healthcare providers to access when necessary.