One Door: Using Lean Transformation to improve the patient experience

October 05, 2017

By: Sue Mendelsohn, Program Administrator and Project Owner of “One Door”

When The Children’s Hospital of Eastern Ontario (CHEO) and the Ottawa Children’s Treatment Centre (OCTC) amalgamated in October 2016, we did so with a commitment to achieving more integrated and coordinated services. In fact, our promise to patients and their families is to provide “one door to access, one story to tell, one health record to be accessed, and one team providing care.” We recognized that intake - the process involved in having a patient enter the system - needed to be streamlined, and using Lean principles in partnership with families was the way to do it. That’s how the idea of One Door was born. 

The intake experience has typically been described as redundant, time consuming, done on the provider’s schedule and location, not based on the family’s needs, and without coordination between entities. We knew all that had to change.

Our goal is to design a new, single-entry point for assessment and treatment of developmental needs so that the process will be simpler for families already dealing with a stressful situation. The last thing anxious parents need is to have to visit several different sites, tell their child’s story multiple times, and do the same paperwork over and over again. We are one organization now, and we want it to feel that way. Smoothing out the intake process and making it as seamless as possible so families can avoid administrative hassles is part of that unification.

We also want to make it easier for referral sources to know where to send their patients. Apparently it wasn’t always clear to referring physicians which door was right for their client. In fact, this is a theme that came up repeatedly when we spoke to referring physicians about their experience with our previous intake system.

The process hasn’t always been simple, mostly because it can be difficult to find the time to bring everyone needed together in one room, but also because humans are naturally somewhat resistant to change – even good change. Getting people to set aside their knowledge of the current system in order to envision something different can be challenging. The members of our multi-disciplinary project team are all keen and engaged, but they are also rooted in what already exists. 

We have faced some minor roadblocks during the process, mostly because it can be difficult to find the time to bring everyone needed together in one room, but also because humans are naturally somewhat resistant to change – even good change. Getting the members of our multidisciplinary team to set aside their knowledge of the current system in order to envision something different was something that we struggled with at first, but they are keen and fully engaged in creating One Door, so they quickly embraced the process.

In addition, because the team members all have years of experience behind them, the knowledge they bring to the table has been a huge gain as we’ve tried to determine best practices for a new process. We’ve been able to leverage that knowledge to build on opportunities.

But we couldn’t have done it without families of former patients who were willing to share their time and provide feedback as we designed One Door. Their willingness to be involved – even though they are already well beyond the intake stage – has been invaluable. Essentially, this is a process we’re building for new clients, so the level of engagement and collaboration demon​strated by our “old” families is something very special. 

Out of the 60 or 70 families of former patients who completed the survey, 10-12 graciously provided more information by speaking in depth about their experiences with our intake process. Many of the same themes came out of those conversations, particularly duplication, and we were able to leverage this valuable information as we set out to design One Door.

Lean transformation is about improving processes for better efficiency. In our case, this transformation will create a positive change that will impact our patients and their families for years to come. CHEO-OCTC will be speaking more about One Door and how lean transformation can impact a patient’s journey at the Lean Health Care session at HealthAchieve on November 7 in Toronto.

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