4 Essential Projects to Improve Primary Care Office Flow for Nurse Practitioners

Last Updated/Verified: Oct 31, 2020

The demand from the healthcare system on providers such as nurse practitioners appears to be growing daily. Whether it's driven by increasing patient volumes or the heightened requirements for insurance reimbursement, it can seem like an ongoing game of catch-up. While the ultimate goal of a healthcare system is to create high-quality and high-value care for its consumers, most of the responsibility ultimately falls on the physicians, nurse practitioners, physician assistants, nurses, and support staff. With ever-changing technology advancements and the continuous evolution of health disparities, it is critical to avoid the "it's always worked, so why change it now?" mentality. At the same time, attempting to achieve these goals without a proper plan can be exhausting, expensive, and inefficient. Therefore, it is important to understand the purpose of quality improvement and how to effectively execute performance improvement programs.

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Purpose of Quality Improvement

Some people question why providers, clinics, and hospital systems even worry about quality improvement, as they perceive it as "fixing what isn't broken." However, that is far from the truth. There are several reasons why quality improvement should be at the forefront of healthcare providers' radar, as it is imperative in the following:

  • Improving the health of the population
  • Enhancing the patient experience and outcomes
  • Improving the provider experience
  • Reducing the per capita cost of care

How to Design a Project

Designing an improvement project is a relatively simple process, and several factors should be considered beforehand.

  • Clinical Setting: What is the available timeline? Which strategy for performance improvement is appropriate for this particular clinical setting?
  • Current Performance: Are there any easily identifiable areas of improvement? Which performance aspect should be prioritized?
  • Patient Population: What are the major features of the clinic's patient population (i.e. age, race, gender, health disparities)? Which intervention will have the most positive impact on the majority of the population?
  • Institutional Commitment: Who will be at the forefront of the project? Who are the key stakeholders? Will this require a financial commitment?

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Plan-Do-Study-Act

A classic approach to the design and implementation of a quality improvement project is the Plan Do Study Act approach. This multistep process systematically breaks down the process and allows for proper monitoring of progress:

PLAN
The first step of quality improvement is to identify a gap in care and define the goals for improving the performance. Quantify the desired improvement and set a timeframe to achieve the goal.
DO
Complete the plan based on the defined time frame, ensuring that the duration is long enough to collect an apt amount of data.
STUDY
Monitor the progress of performance improvement and compare the results to the goal that was set during the planning stage.
ACT
Depending on whether the performance improvement was achieved, move forward with fully implementing, modifying, or resigning the program.

Ideas to Implement Into Daily Workflow

Primary care NPs can take the following steps to make concrete quality improvements in their offices:

  1. Improving Annual Screenings in Wellness Exams: An annual screening can be time-consuming to complete, and time is not readily available in the medical world. However, continuously screening patients is imperative. Depending on the Electronic Health Record capabilities, patients may receive a request via online portal, email, or physical mail to complete and return by their appointment time.
  1. Improving Slot Utilization in Primary Care: Effectively utilizing all available appointment slots is important to providing quality care and access to a patient population. One approach to improving slot utilization is to create a plan that schedules patients as close to the desired time as possible, rather than several days or weeks in the future and sending reminders. Additionally, in the case of cancellations, it is imperative to prioritize patients who were scheduled further out than clinically appropriate.
  1. Increasing the Consistency and Efficiency of Medicare Annual Wellness Exams: Annual Medicare wellness exams are often lengthy, tedious, and time-consuming. However, they are pertinent for the geriatric patient population. To ensure that all patient appointments are consistent and efficient, a clinic may choose certain staff members to serve as the cardinal staff members who manage these appointments. Additionally, creating a checklist or flowsheet for these visits can keep them organized and boost the efficiency of each appointment.
  1. Maximizing Patient and Provider Experiences by Improving Appointment Agendas: Creating appointment agendas can be an effective way to keep appointment times on-track and in turn allow a provider to see a larger patient load. A typical agenda design includes: 
    • Asking the patient to list their concerns
    • Planning the visit by prioritizing immediate issues and saving the other concerns for a follow-up appointment
    • Reiterating the plan with the patient
    • Concluding visit and discussing follow-up

Continual monitoring of primary care workflow leads to efficient patient appointments and potentially better patient outcomes. Appropriate workflows can also reduce the incidence of provider burnout, as providers know what to expect for the workday and can prepare accordingly. If you already have a great workflow in your clinic, check out this list of other performance improvement projects.

Andrea Mosher, CPNP