Background: Dental patients at a Veterans Affairs Medical Center experience delays in patient care as a result of health literacy challenges. Due to misinformation, complicated conditions and interventions, anxiety, and a lack of access to helpful information, many patients are unclear and even unprepared for appointments, treatments, and surgeries. This results in delays, cancellations, and rescheduling of care at an estimated rate of 3-15% per month. The Clinical Librarian conducted an extensive process improvement project in collaboration with an interdisciplinary dental clinic staff to mitigate these challenges and reduce delays.
Description: The Clinical Librarian used a Lean Yellow Belt methodology to comprehensively define the problem, including using an Input-Process-Output tool. Through meetings and observation, she created a process map and collected data which helped identify specific opportunities for improvement. Analysis of the current state process by staff of multiple professions and facilitated by the Clinical Librarian revealed operational barriers and led to more effective root cause analysis. Courses of action were devised in a collaborative manner, leading to buy-in and relevance. By defining countermeasures and conducting PDSA (Plan, Do, Study, and Act), the librarian and dental staff refined their solutions and enhanced them with patient-friendly tools and content. The ultimate solutions relied on information in a variety of formats, including analog and digital, delivered by multiple means, including hard copy, email, Patient iPads, and patient care room monitors.
Conclusion: Staff have now incorporated the new processes into their patient encounters prior to, during, and after appointments. As the solutions were a departure from known processes and methods, roll out was very gradual. This has allowed for further refining of improvements. The evaluation of the project outcomes demonstrated high satisfaction from both Veterans and staff. In addition, there was a 10-20% reduction in care delays and cancellations. As we add topics related to COVID-19, we anticipate further improvement in patients' preparation for and understanding of their patient care--with the added benefit of enhancing the experiences of patients and staff.