Increasing Primary Care Capacity

Professor Retsef Levi and his students are collaborating to improve healthcare efficiency by using a multiple-perspective, systems approach to field research at a primary care practice in a local teaching hospital that cares for 31,000 patients with about 200 clinical and administrative staff.

The Affordable Care Act reforms focus on efficiency and cost savings. As part of these reforms, primary care physicians are searching for ways to improve their practices and contain costs. Some of these efficiencies can be achieved by handing off tasks to other members of the clinical team for patient pre-visit preparation and assistance with physician overload.

This project found significant leverage by improving prescription management. Up to 28 nurses and medical assistants in this hospital's primary care practice, spend part of their time managing drug prescriptions for their patients. The time they spend is equivalent to 4 full-time staff. The practice's clinical staff not only manage the prescription refills, but also respond to frequent calls throughout the day from patients asking about the status of their prescriptions.

A redesign of the clinical operations to centralize the prescription management process is expected to yield time saving for the staff and a reduction in the associated distractions from patient care. This operations management perspective provides research results on how to improve efficiency and performance. The results show that a centralized prescription management system with 2 – 2.5 full-time staff removes the burden from the 28 nurses and medical assistants currently managing the prescriptions. This is a 37% time saving from the current prescription management process.

The shift to a centralized prescription management process will also create the opportunity to build a medication adherence system. Limited information is currently available about prescription purchase and use. Tracking new prescription orders and refills will lead to more effectively managing the health of patients.

Putting this redesign of clinical operations into practice presents the next challenge within the hospital organization. Once nurses and medical assistants have more time available with no need to manage prescriptions, an opportunity is created for physicians to pass some of their workload to the clinical staff. This results in improved efficiency for the physicians who can increase time with patients and see new patients. The transition in workload, initially appears to be an advantage to the practice, but can lead to some cultural and political challenges for the primary care practice.

The next step will be to efficiently utilize excess capacity from nurses and medical assistants to create better outcomes for patients by using an organizational redesign perspective, and recognizing the cultural and political challenges in the hospital. The recommendations for efficiency improvements need to be implemented with cooperation from physicians and the clinical staff.

Two perspectives applied to one challenge – improving clinical efficiency and capacity - can yield a 37% reduction in time spent on managing prescriptions and shifting the excess capacity to increase time with patients. An operations management perspective combined with an organizational design perspective takes an efficiency recommendation and applies a redesign that makes the change more likely to occur in the primary care setting. This multiple approach to redesigning complex processes within a system is a step towards managing the complexity of the fundamental shifts needed to redesign healthcare delivery to reduce costs, and improve patient outcomes.