Vol. 4
Issue 2
2012
Children’s Mercy Works to
Improve Access
to its Clinics
losing wait:
HOSPiTaL INcREaSES EFFORTS TO ImPROVE SPEciaLTY CLiNic AccESS
In 2011, Children’s Mercy treated more than 335,000 children
in our specialty clinics, and every year for the past 10 years
outpatient visits have grown by 5 percent or more. Our ability to
keep up with this ever-growing demand has at times presented
challenges for us and for referring physicians and their patients.
“W
e are continuously taking
steps to ensure that every
child who needs our care
receives our services in a timely manner,”
said Charles Roberts, MD, Executive
Medical Director/Executive Vice President.
“In addition to increasing clinic space, we
have concentrated on making it easier
for community physicians and families
to access our clinics by expanding
clinic hours, scheduling patients for
appointments with multiple clinics on the
same day, and improving communications
with families.”
Expansion
Expansion has been the most visible of
the hospital’s efforts to improve access.
In May 2011, the Primary Care Clinic and
Teen Clinic relocated to the newly opened
Children’s Mercy Clinics on Broadway,
opening up space for Hematology/
Oncology, Orthopaedics, Pulmonology,
Neurology and Developmental and
Behavioral Sciencesclinics to expand at
Children’s Mercy Hospital. Endocrine/
Diabetes and Allergy/Asthma will move to
the Broadway building in fall of 2012, with
Ophthalmology to follow, creating even
more room for clinics at the hospital.
The opening of Children’s Mercy East
in Independence, Mo., in fall 2012 will
include a pediatric urgent care center,
laboratory space, radiology services, plus
the following specialty clinics: Cardiology;
Ear, Nose and Throat; Endocrinology;
Gastroenterology; Hearing and Speech;
Neurology; and Orthopaedics.
Outreach
Beyond the metropolitan area, 22
specialty clinic services are offered in nine
cities throughout Missouri and Kansas. In
2011, these clinics provided more than
4,900 patient visits, bringing care closer
to where our patients live.
In addition, telemedicine is becoming a
key strategic tool to help improve patient
access to services, overcome the barriers
of time and distance and reduce health
care costs. Genetics, ENT, Endocrine and
Emergency Medicine are leading the way
in use of the technology, but plans call
for all sections to incorporate it into their
planning for the coming year.
“The future of health care is taking care of
patients in places where they want to be
seen so that they are less inconvenienced
by the costs of transportation and time
away from work and their families,” says
Laura Fitzmaurice, MD, Chief Medical
Information Officer and Associate
Executive Medical Director.
Process Improvements
Throughout the hospital, clinics are
reevaluating the way we provide care with
an eye toward improving patient flow and
clinic capacity, while maintaining high
quality care. Changes in how patients
are scheduled, creating four-hour clinic
blocks, making clinics available five days
a week, and implementing evening and
weekend hours are some of the options
being evaluated by our clinics. The
success of these initiatives in several of
our clinics is highlighted in this issue of
Physician’s Update.
“We all understand that these changes
are important to our patients, their
families, and physicians throughout the
region,” says Dr. Roberts. “This isn’t
just an access issue. It is a quality of
care issue and one that we take very
seriously.”
CARDIOLOGY CLINIC
MaXimiZiNG CLiNic TimE
C
hildren’s Mercy operates one of
the higher-volume heart centers in
the country and a point of pride for
many years has been patient access to the
Cardiology Clinic.
The Cardiology Clinic had nearly 15,000
patient visits in 2011 and, even with this
volume, in many cases patients are able to
get a next-day appointment.
“Timely access to our Cardiology Clinic
has always been a priority for us, because
we understand that when dealing with
a child’s heart, referring physicians and
parents value immediate availability of
our nationally recognized subspecialty
physicians,” says Stephen Kaine, MD,
Interim Section Chief of Cardiology, and
Associate Professor of Pediatrics, UMKC
School of Medicine.
Improving the Patient Experience
Getting an appointment is just the start of
the process. Reducing the time required for
patient appointments can further enhance
the patient experience. Appointments can
last two to three hours because of the time
required for tests. The clinic has launched
an ambitious process improvement project
to cut that time in half.
“An appointment doesn’t just involve a
patient seeing a physician,” Dr. Kaine
says. “Clinic visits can be very time
consuming because we strive to complete
all necessary testing for the patient
during a single visit. Getting patients
through admissions, followed by an
electrocardiogram and/or echocardiogram,
especially for babies who may be a bit
fussy, takes some time. So, we’re looking
closely at ways to streamline our process
to help patients travel through clinic
more quickly. In the end, this will improve
efficiency, make clinic visits more pleasant
for patients and families and allow us to
add clinic appointments.”
The Children’s Mercy Cardiology Clinic has
14 board-certified pediatric cardiologists,
eight advanced-practice nurses and
two fellows. In its 2011-2012 rankings,
U.S. News and World Report ranked
Children’s Mercy among the best hospitals
in the nation for pediatric heart care in
recognition of the hospital’s experienced
faculty, advanced treatment and research.
Early results of the process improvement
program have been encouraging. Also, the
clinic staff is finding longer appointments
are less frustrating to families if the time
requirement is more clearly defined up
front. With better communication, families
are more understanding of the reasons
they spend extra time in Cardiology Clinic.
For more information about the Section of
Cardiology, call (816) 234-3880.
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Patients can get appointments within: next day, in most cases
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Patient visits in 2011:
nearly 15,000
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Clinic Locations:
Good, Better, Best
“We are always looking at how we can
improve service to referring physicians
and their patients,” says Dr. Kaine. “Being
good just isn’t good enough. We’re striving
for excellence by proactively taking steps
to best maintain our accessibility and
provide the highest quality care for children
needing our services.”
Cardiology Clinic appointments are
available at Children’s Mercy Hospital,
Children’s Mercy South and Children’s
Mercy Northland. In addition, outreach
clinics are available in Junction City,
Kan., and St. Joseph and Joplin, Mo.
The Cardiology Clinic will be among the
subspecialty clinics available at Children’s
Mercy East in Independence, Mo., when it
opens this fall.
Children’s Mercy Hospital
Kansas City, Mo.
Children’s Mercy South
Overland Park, Kan.
Children’s Mercy Northland
Kansas City, Mo.
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Outreach Clinics:
Joplin, Missouri
Mercy Hospital
(formerly St. John’s Hospital)
Junction City, Kansas
Geary Community Hospital
St. Joseph, Missouri
Heartland East Campus
Lakeside Pediatrics
Gastroenterology CLINIC
APPROach EQUaLS DRamaTic REdUcTiONS
C
raig Friesen, MD, will be the first
to admit that the Gastroenterology
Clinic at Children’s Mercy Hospitals
and Clinics had major hiccups when it
came to access.
“We knew our reputation was horrendous
when it came to access,” admits Dr.
Friesen. “That’s not how we wanted to be
perceived in the community regarding our
approach to patient care.”
A year ago, it took as long as 38 days
at times to get an appointment in the
general clinic, which treats everything from
constipation to reflux and inflammatory
bowel disease to celiac disease. For Dr.
Friesen, Gastroenterology Section Chief
since 2009, that was unacceptable.
Today, with the proper resources and a new
approach to scheduling, it takes fewer
than 10 days.
“With a strong commitment
to improvement, our 15 GI
specialists adopted a new
scheduling process that
better utilized clinic time and
physician time to allow for
new patient appointments,”
adds Dr. Friesen.
Fixing Endoscopy Access First
If endoscopy access wasn’t improved first,
there was no point in fixing access to the
general clinic, according to Dr. Friesen.
“If we got someone an appointment
in the general clinic in two weeks and
they needed a scope, but couldn’t get
a scope until two months later, then we
were providing no better service than if
we got them into the clinic in six weeks
and scoped them in two weeks,” says
Dr. Friesen. “It only made sense to start
there.”
In February 2011, there were more than
120 patients on the waiting list to get set
up for an endoscopy. By increasing staff in
the procedure room, securing additional
operating room time at Children’s Mercy
Hospital and opening endoscopy
capabilities at Children’s
Mercy South, that back
log was erased within
a month and patients
were getting
scheduled on the
day the decision
was made and
getting scoped
within two
weeks. That
led to an
additional 140 new patient appointments
available each month.
Staying on Course
With no plans to deter from its recent
access success, Dr. Friesen and his team
have enabled additional measures to put
out any access-related fires before they are
even started:
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A scheduler monitors the clinic’s
appointments daily to address any
concerns.
Specialists on inpatient service
added outpatient appointments
to their schedule, creating 45 new
patient appointments a month in the
clinic.
Each Friday, a physician is assigned
to new patient appointments
reserved for weekly emergent
situations.
An Abdominal Pain Access Clinic
will open this winter, adding 1,000
patients to the program.
For more information or questions
regarding access to the GI Clinic, providers
can contact the Gastroenterology Office at
(816) 234-3016.
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Patients can get appointments within: 10 days
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Patient Visits in 2011:
more than 16,500
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Clinic Locations:
Children’s Mercy Hospital
Kansas City, Mo.
Children’s Mercy South
Overland Park, Kan.
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Outreach Clinics:
Joplin, Missouri
Freeman Health System
Salina, Kansas
Salina Regional Medical Center
Springfield, Missouri
St. John’s Children’s Specialty Clinic
Wichita, Kansas
Mid-Kansas Pediatrics Nephrology Clinic
Nephrology
CLINIC
FOcUSiNG ON TimELY, QUaLiTY SERVicE
T
he Section of Nephrology at Children’s
Mercy Hospitals and Clinics is at the
center of the largest study of chronic
kidney disease in children in the country.
Its six double-board certified physicians are
leaders in the industry in a program ranked
among the top 10 pediatric nephrology
sections in the nation by U.S. News and
World Report.
However, a year ago, when it came to
new patients getting an appointment,
the Section of Nephrology fell short and
patients were waiting more than a month
to get an appointment in the general
Nephrology Clinic.
“We had prioritized a variety of professional
activities that sometimes conflicted with
the time made available for our patients,”
says Bradley Warady, MD, Chief of the
Section of Nephrology. “We had to make a
commitment to change and return to our
primary goal, which is to not only provide
the best care possible to our patients,
but to do so in a timely and high quality
manner.”
Today, any patient can be seen within
a week of calling for an appointment, a
dramatic change in access that Dr. Warady
and his team say is only the first of many
steps introduced to improve how the
Nephrology Clinic operates.
Rapid-Access Approach
To improve access, clinic efficiency stepped
to the forefront for the multidisciplinary
team of specialists and staff.
An enhanced approach to scheduling
helped create a system that allowed for
rapid access to the general kidney clinic as
well as to Nephrology’s numerous specialty
clinics — Hypertension, Voiding Disorders/
Enuresis, Dialysis/Transplantation and
Bone and Mineral Disorders.
The section also began taking more
advantage of the expertise provided by
an experienced staff and a core group of
nurse practitioners, who worked to perfect
the clinic experience by making each stage
of the visit as smooth and as efficient as
possible for the patients and parents.
“The people on the front end — our
schedulers, support staff and nurses —
developed ways for our patients to not
just have an appointment, but to have
the best possible experience while they
are here for their visit,” says Dr. Warady.
“We took the approach that getting them
the appointment they desire in less
than a week is just the first important
step; attention to details like this have to
continue once families walk through our
doors.”
Not Stopping There
Improving access with adjusted schedules
and rapid access is just phase one.
Honing in on creating the best possible
appointment experience, the section is
launching a quality-improvement project
that highlights elements that contribute
to a positive clinic visit, based upon the
feedback they have received from families.
“We want to provide more than just good
medical care,” says Dr. Warady. “We want
to provide excellent, efficient service that
meets all of the nephrology-related needs
of the patients and families that come to
see us.”
To learn more about clinic access in
Nephrology, call (816) 234-3010.
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Patients can get appointments within: 7 days
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Patient Visits in 2011:
more than 5,400
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Clinic Locations:
Children’s Mercy Hospital
Kansas City, Mo.
Children’s Mercy South
Overland Park, Kan.
Children’s Mercy Wichita Specialty Clinics
Wichita, Kan.
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Dr. Bradley Warady,
Nephrology
Outreach Clinics:
Joplin, Missouri
Freeman Health System
General Surgery CLINIC
MiNimiZiNG DiSRUPTiONS, MaiNTaiNiNG LOw WaiT TimES
T
he General Surgery clinic at
Children’s Mercy Hospitals and
Clinics has several moving parts.
The nine board-certified surgeons rotating
in and out of the clinic provide pre-surgery
evaluation or follow-up care for everything
from adrenal diseases to pectus
excavatum to vascular malformations.
Thus, the broad range of surgical services
and the commitment to 24-hour coverage
doesn’t allow for delays.
That’s why the surgeons and staff in the
clinic implemented a system that keeps
the entire surgery team on schedule,
while minimizing the hassle of getting an
appointment for patients and families.
“Our patients can usually get an
appointment within one or two days of
calling,” adds Charles L. Snyder, MD,
Section Chief for General Surgery and
Professor of Surgery, UMKC School of
Medicine. “We have always worked hard
to make sure we are getting patients in as
soon as possible to provide them with the
best care right from the start.”
A Good Reputation
The Section of General Surgery at
Children’s Mercy has experienced
exponential growth in the past 15 years,
Drs. David Juang and
Janine Pettiford-Cunningham,
General Surgery
adding more surgeons to perform
more surgeries. In addition, the section
continues to incorporate research
components into the clinical mix, creating
the Center for Minimally Invasive Surgery,
Center for Prospective Clinical Trials and
the Center for Pectus
Excavatum/Carinatum.
However, with each new addition, the
expectation to keep wait times low
for patients remained a priority and
community providers and parents both
took note.
“Although we always recognize there is
room for improvement, we feel we have a
pretty good system in place to meet the
needs of our patients and the providers in
the community,” says Dr. Snyder. “And, we
not only work to get patients into the clinic
quickly, but we have a process in place to
maintain good return communication to
the community providers.”
Although a year ago the wait time for an
appointment was eight days, some tweaks
to scheduling created more available
appointments and a new wait time of just
one or two days.
Emergent and Elective
Of course, in some cases that come
through the clinic doors, the wait is nonexistent.
“When it comes to emergent surgery
situations,” adds Dr. Snyder, “our set-up
and provider schedules allow for us to
usually see that patient the same day the
provider calls.”
Dr. Snyder also notes that the surgery
staff is always prepared to help with
consults and address any concerns
regarding the program at Children’s
Mercy.
To learn more about clinic access in the
Section of General Surgery, please call
(816) 234-3575. When referring a patient,
please provide X-rays and labs.
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Patients can get appointments within: one or two days
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Patient Visits in 2011:
nearly 10,000
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Clinic Locations:
Children’s Mercy Hospital
Kansas City, Mo.
Children’s Mercy South
Overland Park, Kan.
Nephrology Clinic
Ophthalmology
CLINIC
SEEiNG PaTiENTS PROmPTLY
T
he Section of Ophthalmology at
Children’s Mercy Hospitals and
Clinics had more than 24,000
patients walk through one of its three
clinic doors in 2011. According to
Ophthalmology Section Chief Scott
Olitsky, MD, that makes it one of the
busiest clinics of its kind among similar
pediatric hospitals.
It also makes it pretty astonishing that
even with large patient volumes and
providers spread throughout the city, the
Ophthalmology Clinics have no problems
getting patients their appointments
within a few days of calling.
“The basic philosophy in our clinic is
that we don’t let patients wait,” says
Dr. Olitsky, who is also a Professor of
Ophthalmology at UMKC School of
Medicine. “If that means we adjust our
schedules to accommodate demand, we
adjust our schedules — committing to
staying late to see the patients we need
to see.”
A Full Day’s Work
Throughout the past decade,
Ophthalmology at Children’s Mercy has
grown from one provider to a robust
section with six ophthalmologists and
four optometrists who treat everything
from routine eye exams to complicated
ocular anomalies, five days a week.
“We see a lot of patients and treat just
about every condition,” says Dr. Olitsky,
who estimates that approximately 125150 patient visits occur each day.
With that many patients — both new and
existing — coming through the clinics,
scheduling is a priority.
Each staff member contributes to the
clinical workload, working full work
weeks and seeing patients from 8:30
a.m. to 5 p.m., while still maintaining
research and educational focuses.
In addition, the staff accommodates for
emergency situations in the scheduling
by having a dedicated provider at all
times assigned to the main clinic at
Children’s Mercy Hospital for same-day
appointment needs.
Location, Location, Location
Knowing the importance of access,
the Section of Ophthalmology operates
clinics at Children’s Mercy Hospital,
Children’s Mercy South and Children’s
Mercy Northland.
The multiple locations, which all see
patients four or five days out of the work
week, not only help patients identify
available appointment times, but also
provides a level of convenience for busy
families.
And, looking ahead, the plan is to
relocate the downtown clinic location
this winter to a larger space at Children’s
Mercy Clinics on Broadway (3101
Broadway Blvd. in Kansas City).
“Although, I think we are doing
a good job with access with the
accommodations we have,” adds Dr.
Olitsky, “when we move to our new
clinic, we will have the ability to schedule
patients for same-day appointments —
both routine or emergent in nature.”
To learn more about the Section of
Ophthalmology, please call
(816) 234-3046.
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Patients can get appointments within: one or two days
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Patient Visits in 2011:
more than 24,000
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Clinic Locations:
Children’s Mercy Hospital
Kansas City, Mo.
Children’s Mercy South
Overland Park, Kan.
Children’s Mercy Northland
Kansas City, Mo.
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RACE for Results
Recognizes Wait Time
Improvements
With a shortage of pediatric
subspecialists and high demand,
many patients experience longer wait
times to receive care in hospital
clinics. Children’s Mercy has
been working to decrease the
average wait time for new patient
appointments. As a result of the
hospital’s commitment and
solid results, Children’s Mercy
recently was recognized in
the 2012 RACE for Results
award program.
Sponsored by the Children’s
Hospital Association, the
prestigious program recognizes
those children’s hospitals that
have achieved exceptional clinical
and business improvements.
Children’s Mercy has been aggressive
in its efforts to improve patient satisfaction.
Within 12 months, 50 percent of pilot clinics were
offering available appointments within 10 days, down
from the average wait time of 25 days. These advancements
were achieved through initiatives including scheduling script
development, developing standards, building employee
engagement and dedicating Quality Improvement managers to
help each clinic work through scheduling challenges. Children’s
Mercy remains focused on ensuring patients and families get
timely access to the care they need.
How To
Refer
For Transport,
Inpatient
Admission or for
Consult
1-800 GO MERCY
(1-800-466-3729)
Call this number 24 hours a day to
mobilize the in-house neonatal or
pediatric transport teams, consult
with a specialist, or admit a patient
directly to Children’s Mercy Hospital or
Children’s Mercy South.
For Specialty Clinic Appointments
(816) 234-3700 or
toll free 1 (800) 800-7300
Nurses with our Physician Appointment
line can assist you with scheduling
clinic appointments for Children’s
Mercy Hospital, Children’s Mercy South
and Children’s Mercy Northland.
Physician’s Update is produced by
Communications and marketing.
Shawn Arni
Editor
Megan Stock
Assistant Editor
Bill Van Kirk
contributing writer
For more information, call
Communications and marketing at
816-346-1370.
For more physician news and
information, visit our
Physician News portal at
www.childrensmercy.org/physicians.