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As the Senior Administrator of the Diabetes and Weight Management Service Line in your organization, you are not looking forward to the Senior Administrators Directors (SAD) Meeting this month. The distance between expected and actual budget numbers continues to widen for practically all areas, most notably for outpatient clinic visits where you are running 7.2% behind budget. This deficit is even more puzzling as your Wait Time for New Appointments is the second longest of any service line in the organization. The CEO, in fact, mentioned at the last meeting that he is getting heat from the Board of Directors from patients in the community who are complaining that they can’t be seen in the clinic (and rumors are out there that there are many who are choosing to go to the University for not only their outpatient care but also the lucrative stomach-stapling surgery that many require).

At your last Service Line meeting with the physicians (which seemed more poorly attended than the last one), your slide show graphs were met with blank stares (for those not already tapping on their phones). Your request for ideas was met with the same responses as at each meeting: “We are down two physicians and need more help.” When you gently mention that their productivity targets are down, your idea is met with a general grumbling led by the physician leader of the group, who once again states that they are all working harder and staying later than they ever have.

The patient satisfaction numbers are no better, among the lowest in the organization for outpatient care, with only 54% of patients feeling that they could get an appointment in a timely fashion, 61% feeling that their concerns were heard and that they were treated with respect by the staff, and an abysmal 48% agreeing that they would recommend the service to others. And these will be in full view in front of your fellow senior administrators in one short week. In addition, the future looks no brighter, as two APCs in the past month have resigned, stating that they are overwhelmed with the work and lousy morale.

At your managers meeting this morning, you can sense the low energy from the nurses who run the outpatient clinic. The Nurse Manager in fact groused that another staff nurse was leaving for the GI lab and complained that no new patients are getting in because the attendings are seeing almost all follow-up patients and leaving the lengthier new appointment slots to the APCs, most of whom are new and “take forever to see their patients”. On her way out, she requested that you “come by and see for yourself how burned out everyone is over there”.

To top it off, the agenda for the SAD Meeting this month is different: instead of each Service Line reporting equally, it appears that a large chunk of time is assigned to “Diabetes / Weight Mgt Service Line Update.”

Be sure to address the following in your assessment:

  • A systematic approach to the problem and processes
  • Why it is important to the organization
  • What quality improvement tools could be employed in the process
  • How to engage clinical practitioners in the process
  • How success will be determined
  • What processes will be employed to ensure sustainability