A woman calls with chest pain and dizziness. Your staff has only a few minutes to ask the right questions, analyze her health records, determine potential diagnoses, weigh the potential risks, settle on a recommendation, document it properly, update her digital records, coordinate with her physicians, and schedule an appointment – or call 911.
In addition to that, your staff has to make sure their decisions align with your organization’s policies, satisfy HIPAA regulations, and adhere to the latest medical science at every step of the process. This happens dozens of times a day.
I have a name for this kind of avalanche of crushing complexity: clinical combinatorics. Combinatorics is the study of permutations and combinations. In health care, we see that surface from the tremendous complexity of our discipline. Clinical combinatorics freezes organizational growth, decimates efficiency, and makes your staff and your patients miserable.
Clinical combinatorics leads to a particular trap I’m sure most health care organizations are familiar with. On the one hand, the only way to do everything right is by relying on a mishmash of tribal knowledge – the undocumented information, rules, and techniques shared among workers at health care organizations, which staff members learn slowly over months or years. But the price of maintaining that tribal knowledge is burnout. No organization can keep it up, and certainly not in health care where health and lives are hanging in the balance.
Many organizations believe that, to meet HIPAA regulations and ensure their physicians maintain control of their scheduling preferences, they have no option but to battle clinical combinatorics barehanded, every single day. But that’s not true. It’s possible to slice through the chaos and break free of the exhausting manual processes that so many organizations have grown hopelessly addicted to.
Digital tools to streamline workflows
You no doubt heard this before, but it’s true. Digital transformation has the potential to revolutionize the health care industry. But the problem isn’t accepting that digital transformation, it’s implementing it. Most health care organizations just don’t have the bandwidth to find ways to integrate new digital tools because they’re too busy keeping their heads above water. You can’t do it piecemeal. If you’re serious about getting out of clinical combinatorics, here’s the strategy I recommend.
The first step is to standardize and document your existing processes. Map out the exact steps for common scenarios for scheduling appointments. For example, document the end-to-end process for when a patient calls to schedule a first appointment. Mapping out the precise steps involved in common scenarios makes the “why” and “how” behind complexity visible, allowing you to address it systematically.
Breaking down data silos is also critical, and this requires developing modular templates of patient scenarios. First, create templates for average and complex patient scenarios, then customize them for different providers, care teams, and locations. For instance, Dr. Jones prefers 15-minute return visit slots while Dr. Smith blocks out 30 minutes. The template for Dr. Jones’s schedule would differ from Dr. Smith’s.
Next, build comprehensive 360-degree profiles. A patient 360 would aggregate the patient’s medical history, risks, demographics, and all the other information a health care provider would need in one place. A provider 360 would capture specialties, procedures, preferences, and practice patterns. A location 360 would include variables like hours, services, and staffing.
These profiles provide context about which templates to apply for unique individuals and situations. For example, a patient 360 could indicate a patient requires extra time due to multiple chronic conditions and mobility issues, which would prompt assignment to a provider with longer return visit slots.
Everything I’ve mentioned up till now is doable with Microsoft Word and doesn’t actually help things on a holistic level. The real magic happens with the automation of your processes using AI and chatbots. Use chatbots for basic customer service and triage to simplify initial interactions. Employ AI to analyze historical visit patterns and refine your scheduling process.
For instance, AI may determine that based on three years of appointment data, staffing the phone center with four employees from 8 a.m. to 10 a.m. and three from 2 p.m. to 4 p.m. could reduce wait times. Chatbots could answer basic FAQs about wait times or office hours before patients call. While chatbots have a bad rap for being frustrating, innovations in the AI text generation space have made them much more bearable and useful tools.
Using your modular templates and AI, create digital self-service options that give patients convenience and control through online appointment booking. Offer online self-scheduling that uses the patient 360 data and the modular templates to create fully automated scheduling flows that allow your patients to book their own appointments digitally rather than calling.
Modular templates can be customized for patients, presenting only options that apply based on their 360 profile details. For a diabetic patient, the self-scheduling portal may focus on booking primary care, endocrinologist, and nutrition visits. For a cancer patient, the system can streamline booking oncologist and infusion clinic appointments.
Finally, no matter what technological service you end up adopting, you need to keep a close eye on your analytics to continuously hone and optimize these processes. Monitor KPIs like patient satisfaction, wait times, abandonment rates, and staff productivity to pinpoint improvement opportunities. If necessary, you can adjust workflows, automate additional processes, or reallocate resources.
For instance, if callers frequently abandon the queue due to long wait times and understaffing during the 12 p.m. to 2 p.m. peak period, consider shifting more resources to those hours based on actual demand. Analytics-driven optimization can help achieve the ideal balance of technology, staffing, and customization for the organization’s unique needs and population.
Improving patient outcomes
By streamlining scheduling and workflows, you make the lives of your staff easier. They’re happier, less stressed, and less likely to make mistakes, which affects patient outcomes. But digital tools can have direct impacts on patient outcomes, too.
Creating an online scheduling and record-keeping system puts the power and control in the hands of your patients. Studies show breast cancer patients using online portals to track appointments, view oncologist notes, and monitor treatment plans reported feeling less distressed and worried, and more confident in managing their care.
When it’s simple and convenient for patients to adhere to treatment plans, adherence goes up. When it’s easy to figure out when and where your appointments are, they’re easier to keep. Self-scheduling, automated appointment reminders, and mobile messaging make it easier for patients to interact with providers and stay on top of their health. According to research, the easier and faster it is to navigate the extremely complex American health care sector, the higher the compliance and thus the greater the likelihood of achieving desired outcomes.
Final thoughts
Clinical combinatorics need not be the death knell of patient access operations. Digital tools can simplify that complexity. The key is a human-centered approach to digital transformation.
To solve clinical combinatorics, we’ll need to standardize existing processes, reimagine resource and workflow design. We’ll also need to offer both self-service and human touchpoints, and continuously measure and optimize our systems. When refined for your organization, AI and other technology can slice through complexity to free your staff to focus on compassionate care.
Conquering clinical combinatorics requires drastic changes in ways of working that may be daunting, but the outcomes are worth it. Patients receive the seamless and personalized experiences they deserve, and organizations gain the agility to flourish in an increasingly digital, on-demand world.
Stephen Dean
Stephen Dean, Co-Founder of Keona Health, a health desk that makes omnichannel patient access fast and simple.
