Two weeks ago we instituted a quality assurance program at our clinic for patient/referring office complaints. Normally, when someone complained we had whoever received the call deal with it and if they couldn't the complaint escalated up the ladder. The piece of the puzzle that was missing was how often people complained. For all I knew the front desk was dealing with 5 or 6 major complaints week.
Well Rule #10; "If you don't take a temperature you can't find a fever" bit me right in the ass. We started tracking the complaints. So far this week, we've had 3 (one was about me) and counting. I'm quickly finding out that sometimes you can't improve the situation but recording, acknowledging and trying to find a solution to a complaint is good customer service in-and-of itself. Recording the complaints also lets us look for patterns.
When I read about Paul Levy discussing a wrong limb error and John Halamka reflecting on how to leverage IT to minimize intra-operative errors our clinic concerns seem like small potatoes. But when you consider that most medical care is conducted in small clinics throughout the world small changes in quality assurance can make a big difference. I often wonder what the minimum standard should be for clinics in terms of quality assurance to ensure that biopsies are not forgotten, blood work is checked and patients are recalled for critical appointments.
I know that when our clinic transitioned to an electronic recall/treatment tracking program our follow-through changed by roughly 20%. It stands to reason that other tasks which require human follow-up improve when automated. If we can't track it however, we'll never know what we're missing. I'd ask the following question of clinicians -- if you're front desk failed to follow-through on a biopsy, bloodwork or critical appointment is there any way that you could tell? If you can; do you know what the error rate is and are you working to minimize it?