When Presbyterian Healthcare System took a hard look at its state of affairs in scheduling, it counted 38 different inpatient and outpatient locations at its flagship hospital where patients could be scheduled for a medical event.
Physician offices and other hospital customers had to navigate that maze by phone to arrange for patient procedures, and they had to adjust appointment-making routines that changed from location to location.
"Everyone was doing it their own way," said Shyrl Johnston, manager of the project to change all that.
The project's aim was to centralize scheduling at Presbyterian Hospital in Dallas as well as the other three hospitals and affiliated clinics in the healthcare system. Instead of making people go through individual departments, the system established a dedicated phone number to handle all scheduling, Johnston said.
It was up to Presbyterian to make that one-call philosophy work by reorganizing its operations and adding information-systems support to make scheduling "fast, friendly and customer-focused," she said.
Three years later, the healthcare system is poised to launch a new information system for scheduling this summer at Presbyterian Hospital of Dallas and Presbyterian Hospital of Plano. Eventually the software system will be phased in systemwide.
Getting to the implementation phase involved technical preparation as well as a concerted effort to win over skeptics at the department level who said it couldn't be done, Johnston said.
The effort started with an assessment and evaluation of appointment scheduling throughout Presbyterian Hospital. At meetings, project leaders asked department leaders and anyone who had anything to do with scheduling for feedback on the system as proposed.
At the same time, the leaders tried to "create an awareness of what was going on and what our customers were telling us,"Johnston said.
A management engineer was brought in to help deal with the organizational issues of systemwide scheduling and to raise the "comfort level" of employees.
Asking for feedback also gave the implementation effort a way to correlate software features to established practices that were working well, said Jeffrey Pferd, vice president of programs and training at Insource Management Group, a Houston-based re-engineering firm that worked on the project.
Employees were concerned that a new information system had to be flexible enough to schedule the way their department works, said Patricia Lawson, a systems specialist in charge of implementing the software.
The new system also had to be capable of connecting to the information systems of departments such as radiology so the data would not be duplicated, Lawson said.
And issues such as flexibility on scheduling authority were brought out as important measures to build into the implementation. Managers made sure to negotiate the point where a department takes over in emergencies and other sudden priorities, Pferd said.
Presbyterian's self-assessment soon revealed that it had a change-management project much wider than first thought, Pferd said.
To achieve the goal of handling all appointment-making in one call, scheduling had to be merged with managed-care considerations such as pre-certification and authorization of treatment. But the implications of coordinating benefits information and insurance authorizations with the resource management process were underestimated, he said.
Achieving that level of coordination required much more than winning over the clinicians. "A lot of the original resistance is behind us," Pferd said. That's been replaced by concern about the scattered and disorganized process that had sprung up over the years to confirm authorizations, call patients and providers about benefits issues, and reduce payment denials.
An internal study tracked losses of up to $150,000 a month in payments denied because patients either weren't eligible or weren't cleared in advance for treatment, Pferd said.
Unless the organizational response to benefits management was streamlined, Presbyterian would continue to lose money on payment denials. The scheduling function had to be integrated with the managed-care contract management information system, which keeps track of details about authorized treatments and terms of payment.
In addition, the central business office had to be brought into the implementation, with its own set of concerns and routines to consider. That was a new dimension for resource scheduling, which had been clinically and departmentally focused.
The integration meant clerical registration employees, who previously dealt mainly with routine questions, needed a better grip on the complexities of healthcare delivery. "The level of expertise is significantly different, and that's a challenge of change," Pferd said.
Presbyterian would like to have one person move a patient all the way through the system by taking into account financial and patient-care variables, "instead of asking, `And what time did you want to come in?"' Pferd said.
A limited expansion of a Presbyterian Hospital software system for surgery scheduling already is demonstrating the potential for scheduling automation, Johnston said.
The departmental system was expanded to handle scheduling for the gastrointestinal medicine, pulmonary, catheterization and lithotripsy laboratories as well as for the women's diagnostic breast center, she said.
Meanwhile, time studies revealed that scheduling duties were being handled part time by a number of employees who also were doing clerical and other work.
The automation and reorganization at the hospital resulted in the elimination of three full-time positions in the first year, Johnston said. The effort also focused attention on the customers trying to line up appointments.
Because scheduling had been spread among numerous departments and employees, customers called the same general phone numbers that handled all other departmental business. Since November 1995, a dedicated number has centralized the scheduling routine, Johnston said.
The implementation of Pathways Healthcare Scheduling, a system purchased from Atlanta-based HBO & Co., will provide greater technical capacity to expand scheduling to other sites, she said.
The system launch is being timed with the implementation of a new patient-accounting system from Shared Medical Systems, Malvern, Pa., said David Muntz, vice president for information systems and telecommunications. The coordination will reduce the expense of building connections.
The SMS Invision system will include a feature called an enterprise access directory. The directory tracks information on patients throughout a healthcare system and will be designated the reference location for patient data in cases where a patient has conflicting information in various databases, Muntz said.
The capital expense of installing the scheduling system, including personnel costs and the construction of an interface to the SMS system, is slightly more than $1 million, he said.