Turning chaos into quality: Teams showcase improvements made during pandemic

October 13, 2020  //  FOUND IN: Our Employees,
Top: Team members with the glaucoma clinic carry out drive-thru service. Bottom: HITS helped thousands of staff members transition to remote work.

The COVID-19 pandemic created many challenges — particularly for health care organizations like Michigan Medicine — as faculty and staff had to balance providing world-class patient care with keeping their colleagues and themselves safe.

Transitioning to a remote working platform also created unique circumstances as departments across the organization shifted staff to off-site locations.

But none of that stopped teams from carrying out the organization’s mission of advancing health to serve Michigan and the world.

Here’s a look at a few areas that exemplified how two of Michigan Medicine’s core values — teamwork and innovation — helped them turn a pandemic into an opportunity for quality improvement.

Drive-thru patient care

In the early months of the pandemic, many ambulatory clinics were temporarily closed. While this helped keep patients, faculty and staff safer by limiting exposure to the virus, it created many obstacles to providing care.

“Thanks to improvements in technology, telehealth and e-visits are a great alternative for many in-person health care visits,” said Jennifer Weizer, M.D., professor of ophthalmology and visual sciences at Michigan Medicine. “However, patients with glaucoma usually require an in-person appointment to have their eye pressure measured, so we had to come up with a way to treat these patients.”

The team in the glaucoma clinic in the Kellogg Eye Center quickly got to work establishing a drive-thru location. The clinic utilized a one-lane, one-way drive adjacent to a clinic entrance. Patients were instructed to wear a mask and be on the passenger side of the car when arriving, making it easier for a technician to obtain the intraocular pressure (IOP) measurements. Patient answered COVID-19 screening questions prior to the visit and were discouraged from arriving if they were experiencing symptoms.

A technician dressed in full PPE was able to approach the car, confirm patient name and date of birth, ask more COVID-19 screening questions and measure IOP. This information was recorded and relayed to the attending physician, and a video call was scheduled within the next three days.

“Our team really came together to create a safe way to provide much-needed care for our patients during this pandemic,” said Weizer. “I hope our clinic can serve as a model for others if we are ever again faced with a need to provide patient care in a time when in-person visits are risky.”

Monitoring blood supply

In conjunction with the temporary closure of ambulatory sites, the organization also paused elective surgeries. At this same time, a change in organ allotment increased the number of available organs to Michigan Medicine for use in transplantation surgeries. 

“While the increased availability of organs was great for our patients, the pandemic created a concern about adequate blood supply and the blood bank was beginning to experience a shortage of red blood cells,” said Robertson D. Davenport, M.D., professor of pathology at Michigan Medicine. “We were concerned about being able to support our colleagues and patients with the blood supply needed for surgeries when the national blood supply was in flux, and we could not reliably predict day-to-day availability.”

Social distancing and other restrictions made it more difficult to continue receiving normal volumes of blood donations, reducing the overall supply available. Finally, the team also realized that the hospital command center did not have ready access to the organization’s blood inventory to determine if critically-ill patients could be safely transported and cared for at Michigan Medicine.

A quick look at the blood inventory dashboard from earlier this year.

“In order to better meet the needs of our colleagues and patients, we established two goals — to increase access to the blood bank inventory and reduce the time it took people to access the inventory,” said Davenport.

As part of the solution, the team created an inventory dashboard that was accessible by blood bank staff and hospital administration. The new form utilized a color coding system, making it easier to determine “at-a-glance” if blood supply was adequate to approve a patient transfer for transplant surgery.

“Our intervention was successful in providing quicker access to blood supply inventory, enabling the hospital command center to better determine our ability to provide care for patients in need of organ transplantation,” said Davenport.

Transitioning to remote work

As the pandemic spread, Michigan Medicine quickly shifted to a remote working model for many faculty, staff and learners. This transition impacted every department across the organization, most notably Health Information Technology & Services (HITS). 

“Shifting to a remote work environment is not as simple as taking your computer to a new location and turning it on,” said Michael Warden, senior director of HITS Business IT. “While our hope is always to make things seamless for our customers, there is a lot of work that needs to be done on the back-end to ensure we can handle thousands of remote workers.”

In the first week of COVID, calls and tickets to the HITS service desk increased dramatically, resulting in a 159 percent increase in the average speed to answer, negatively impacting patient care and employee productivity. The HITS team quickly got to work on implementing enhancements to reduce wait time and improve the customer experience. 

“As a team we realized that COVID-19 created a situation that would strain our existing systems and resources in ways we had never experienced before,” said Warden. “As part of our root cause analysis, we identified trends to better understand what questions were high-volume drivers.” 

Based on this analysis, the team updated the internal “remote work from home” troubleshooting documentation, expanded external self-help resources and a “tech guide to working remotely,” enacted a new remote work from home phone tree prompt, proactively monitored calls that had over a 30-minute “handle time,” and implemented a virtual chat agent to automatically support remote work from home topics.

“Thanks to the hard work of our team, these interventions resulted in a transformed service desk experience,” Warden said. 

In fact, in a matter of weeks, the abandonment rate of calls hit record lows, the critical clinical calls were answered on average in 20 seconds, all other lines in about 40 seconds, and the team reduced call handle time by 67 percent.

“Perhaps most importantly, our customer satisfaction ratings hit record high levels,” Warden explained. “Even now, when the majority of our workforce has completed the transition to remote work, we are still experiencing higher than normal call volumes so we are continuing to add additional supporting metrics and countermeasures to ensure we are meeting needs and expectations.”

The team plans to continue reducing call volumes by evaluating high-volume topics and updating materials to further improve service design and knowledge.

The work of these teams and many more are being highlighted during October in celebration of Quality Month. To see all of the Quality Month posters and find a calendar of events, visit the Quality Month website.