Problem Reporting

One of the easiest and yet most important avenues of ensuring aligned practice objectives is to address outliers. Outliers occur when things don’t go as they should, targets are missed or there are problems or complaints. These events are flashing warning lights that practice objectives are not aligned. If a practice objective is to treat patients with respect, having a patient wait in the waiting room 45 minutes past their appointment time is indication that something went wrong.

Mistakes will happen. Staff members will oversleep or have transportation issues. Providers will have to take longer than planned with some patients. The EMR and practice management systems will have an occasional glitch. The issue is that even “little” mistakes can lead to bigger problems in the future. It would be nice to think that applying my sage wisdom would allow a practice to eliminate mistakes, but we all know that this is—besides being perhaps delusional—not possible.

Think about the Titanic in the schema of mistakes. If the Titanic had struck a smaller problem, like an ice cube, the ship would have bene fine. The Titanic’s problem was actually much bigger—an iceberg—that caused the ship to sink. While the size comparison between an ice cube and an iceberg is ridiculous, only a small part of an iceberg is actually visible, (“the tip of the iceberg”). In identifying potential problems, then, the analogous question is, “What is an ice cube and what is the tip of the iceberg?” What problems are insignificant if not thoroughly address and what problems will sink the practice?

My solution is to track and trend the “little” problems to see which might represent a larger problem. In the past, I have used the two following forms to track and trend problems. The first form is a Report Sheet for tracking more complex problems that need to be addressed. The second form is a Report Log for tracking smaller problems that may or may not require a more formal investigation. I kept both forms in a binder so that I could review previous issues. 

Practice Report Sheet (Word) (CLICK HERE)

If a patient was in the waiting room 45 minutes past their appointment time, for example, I would have the staff start a Report Sheet with the relevant information, (date, time, patient, staff, etc.). I would take this Report Sheet and I would talk to all of the staff members who were involved, getting their perspective on what lead to the issue. I would include the patient’s perspective, either from a staff member or by talking to the patient myself. I would note the action take, including instructing the staff to scan the waiting room every few minutes and account for those present, apologizing to the patient and informing the provider of the issue.

When I felt that the issue was resolved, I would file the Report Sheet in my binder. Having this record was invaluable if a similar situation happened again. Without the Report Sheet, the details could be lost or forgotten. With the Report Sheet, I can look for common threads in staff, patients, time and situations.

One of the issues our office had in the days of paper charts was that some patients were being roomed early while other patients were being roomed late. While this can happen based on how patients arrived, after reviewing a couple of instances, I found that the front desk put the charts in the “To be roomed” bin expecting the medical assistants to sort by time. The medical assistants assumed that the front desk was sorting the charts by time when they put the charts in the bin. If the medical assistants always roomed the patient whose patient chart was in the front of the bin, the patient whose chart in the back could be left waiting. To address this problem, we agreed that the front desk sorted the patient charts in the “To be roomed” bin by appointment time.

Practice Report Log (Word) (CLICK HERE)

Some problems don’t require an investigation but still need to be tracked: an employee shows up late, the cleaning crew misses an area, the phone system mysteriously reboots. I used the attached report log to track and trend these problems or to have the staff track and trend problems. A Report Log can be a catch all list of problems or each sheet can have a “topic,” like “late arrivals” or “problems with Jane” to help organize potential issues.