Reference no: EM131937868

Problem Statement:

The challenging referral process for Maternal Fetal Medicine is causing a 24-48 hour delay in scheduling patient appointments, resulting in decreased patient satisfaction. The goal of the office is to have all appointments made within 24 hours of receiving the referral.

History and Problem

Describe the client/organization by providing some background and describing the context in which the business problem or need occurs. Do not use the client/organization's actual name (unless the client is a legal nonprofit with 501 (C3) status).

How long in business?

Type of business?

Size of business (customers served, approximate annual sales or revenue)?

Management structure?

Legal structure or form of the organization?

Relevant recent events? Be sure your detailed description includes the following:

• history of the company (organization's bio)

• detailed description of the product/service offerings

• target market/competitive landscape

• location (general region)

• culture

• context in which the problem is occurring

Note: If this information is sufficiently detailed, you can copy it over to task four.

Indiana Health Network (IHN) is a locally based, non-profit health network located in central Indiana. IHN came to creation after the residents of the east side of Indianapolis realized that the community did not have any options when it came to a hospital without having to go to downtown Indianapolis. In 1950 community leaders, civic organizations and countless neighbors began going door-to-door to raise funds to build a hospital close to their community and the goal was to raise twenty million dollars. As a result, the doors to IHN opened in 1956. Now 60 years later, IHN has over 200 sites of care that include: three major hospitals, physician's offices, behavioral health clinics, immediate care clinics, surgery centers, home health centers, and several others.

However, IHN has one Maternal Fetal Medicine (MFM) clinic. The MFM clinic receives referrals from OB/GYN's throughout the entire state of Indiana when they have a pregnant patient who has become "high risk". A practice manager and a physician partner lead the office. MFM is sufficient regarding their referral process. Due to the urgency of patient care, all referrals need scheduled within 24 hours. The importance of this urgency can mean life or death. A network push for electronic referrals has caused a delay in patient scheduling due to insufficient details on the referral, which causes the referral coordinator to have to spend time calling the referring physicians to clarify the incoming referral.

Maternal Fetal Medicine is an office of 22 employees, which is composed of physicians, nurses, medical assistants, genetic counselors, and ultrasound technicians. The office has a practice manager on site, which is myself, then a group practice director (GPD) who is over all OB/GYN offices in the network. As you can imagine, the GPD is spread out very thin so office operations are the responsibility of the practice manager.

While there are other MFM offices in the state of Indiana, this particular one at IHN receives a majority of the patient load due to the level 3 NICU that is also available to these mothers. With IHN MFM is receiving a majority of the referrals, it has a significant gross charge report. On a monthly average, MFM brings in 247,933 dollars in gross charges. After insurance reimbursement, staff salaries, and basic office needs, MFM typically comes out with 139,738 dollars in revenue.

When did the organization become aware of the problem? What actions, if any, have been taken to mitigate the problem?

MFM became aware of the problem immediately upon receiving electronic referrals in June 2017. Since that time education has been rolled out to all referring providers in the network on how to properly place outgoing referrals.

Functional Areas

What three functional areas might be contributing to the problem? Describe why these functional areas are contributing to (causing) or are affected by the problem. Do not focus on the solution when identifying your functional areas. Recommendation: Complete Step 5 in the Creating an Effective Problem Statement to generate ideas.

Important note: Although, the course instructor team must approve your problem statement and may discuss functional areas, please keep in mind that problem approval does not include approval of possible functional areas. Functional areas emerge after root cause analysis and must be clearly supported in the business proposal.

Customer Service: Maternal Fetal Medicine referrals cause stress and anxiety to expecting mothers. When a significant amount of time has passed from the date the referral is place to the patient being notified with an appointment, it causes the patients to become angry and most of the time the patient has reached out to competitive hospitals to schedule an appointment. Patients being upset and going elsewhere for care, results in lost charges and revenue in the end.

Medical Care: Disconnects between referring providers and MFM causes delays in patient care due to not being able to have a smooth referral process. Patient conditions can significantly change in 24-48 hours, which is why it is the offices priority to call everyone in at least 24 hours.

Business Operations: Insufficient referrals causes the office to have to use additional resources which results in a loss of revenue. MFM has had to hire an additional staff member to handle these referrals now. In the past the nurses and medical assistants handled it but they are unable to now due to the additional unnecessary work.