In searching for ways to enhance the overall experience for patients and their families, Nemours Children’s Health analyzed its value stream—each step along a patient family’s journey with the hospital. It found it could spark significant improvements by rethinking how many families first engage with Nemours Children’s: the patient referral.
“We made it our primary focus to make sure the children get the care they need,” says Kellie Olmstead, MBA, vice president and chief transformation officer at Nemours Children’s Health in Jacksonville, Florida. “We're not talking about converting something in a work queue; we're talking about getting a child to the right provider—that nuance made a really big difference.”
In ensuring that patients referred to Nemours Children’s ultimately receive care, the hospital has seen a dramatic increase in referral conversions over the year—from 70% up to 86%.
Strategies to increase the patient conversion rate
Achieving that jump in patient conversions required examining the entire patient process from the beginning:
Identification. To fully understand the factors driving down referral conversion rates, the leadership team convened a multi-disciplinary panel of internal and external stakeholders to observe the referral process firsthand—from how providers transmitted referral information to how Nemours Children’s received and processed them. Among the primary causes of unfulfilled referrals: the hospital was only attempting two phone calls to referred families, and providers weren’t able to schedule appointments for the patients they were referring directly with Nemours Children’s.
Communication improvements. Feedback from internal and community health care providers informed simplification of communication and scheduling practices to make referring patients easier. This includes the regular distribution of recap reports to referring providers with conversion metrics and recommendations from schedulers to enhance effectiveness, such as complete and accurate patient contact information. The hospital also created a dashboard for its liaisons to see all referral activity and work with referring offices to close the loop. “It's the relationship piece across the board for us,” Olmstead says. “If we're not helping to advance the care of a child, that's a reflection on the primary care office and we've got to be really mindful of that.”
Workflow enhancements. Reviewing referral follow-up processes with scheduling staff prompted changes to contact methodology, including adding text and email attempts to phone calls. Nemours Children’s also began encouraging its own primary care locations to directly schedule referral appointments while the patient’s caregivers were in the office or providing a QR code to the family to schedule later more easily, if necessary.
Olmstead says a key factor to maintaining successful patient conversion rates is to continuously monitor the process and make adjustments as needed. “We have different stakeholders check all the way through the improvements and run these with a pretty tight plan-do-check-adjust (PDCA) cycle that can go either 90 or 180 days,” Olmstead says. “We want feedback from all affected parties to make sure there are no unintended consequences—it's a crisp method, and it’s very inclusive.”
Advice for improving the patient referral process
Though Nemours Children’s Health has been consistently seeking improvements to the patient family value stream for more than a decade, Olmstead says it’s crucial to continually analyze the data to understand where lapses may appear in the cycle and opportunities for improvement may exist. Key to remedying those issues is a multi-disciplinary approach.
“Bringing together a cross-functional team to see each other's contributions is, to me, the only way to go,” Olmstead says. “It lets you leverage each other's realities. It creates a team environment that's just been remarkable.”
