OKC County Clinics Use Patient Navigators to Double Patient Load while Providing More Complete Care
Success StoriesTre Williams, COO of the Oklahoma City County Department of Health, explains how his agency leveraged PHIG to improve patient care and clinic efficiency. They used PHIG funding to conduct workforce training assessments and determined that they needed a quality improvement council. The department launched the council, who conducted a clinical flow project. One of the main findings of that project was that the clinic was missing opportunities to connect patients to needed services, and that there were inefficiencies that were creating appointment backlogs. To resolve these issues, the department hired patient navigators to guide patients through the clinic and larger health department system.
The results? With patient navigators in place, the clinic has doubled the number of patients they see in a day, and patients are consistently getting connected to needed resources like SNAP benefits, housing assistance, and WIC. Through these improvements, the Oklahoma City County Department of Health is not only serving more patients, but maximizing the time each patient spends in the clinic.
Video Transcript
This transcript has been lightly edited for clarity.
How have you been able to use PHIG funding?
The Public Health Infrastructure Grant (PHIG) for us has been something that has not only prepared us for today, but is also helping us prepare better for the future. Our programs at the health department, prior to PHIG funding, were sort of siloed. The programs operated in a fashion where “this is my role, this is what I’m contributing, and this is how I’m going to move forward with my public health career.” So in a place like the clinic, where people come for various different things — immunizations, overseas travel, and all sorts of things— those individuals would come for appointments and get seen for those very specific things. And then doing follow-up surveys, we’d learned that those patients always have more needs and more things that could have been addressed with just a referral or some sort of engagement through the process. For a long time, being in population health–based care, our focus was to see as many patients as we could see, which we were doing pretty well at, but we learned along the way that certain things we could cover better.
How did you find out how to improve patient experience in your clinics?
We conducted the workforce training assessment using PHIG funds, which gave us a ton of context and behind-the-scenes answers into some of the things that patients had indicated to us through their different experiences, surveys, and stuff like that. With that assessment, we determined that we needed to create a quality improvement council. The point of that council is for our leadership and management team, and also patient comments, to bring all that together and figure out what projects we need to take on as a health department to make providing patient care to high volumes of people better.
What programs launched as a result of this assessment?
One of the projects we did was a clinical flow project. In that project, we were trying to determine what things we are potentially missing when patients come through the door. Through that project, we learned that some patients have literacy issues, some don’t understand the point and purpose of the paperwork and questions, and some simply wander off and get lost in the building and clinic a little bit. We were trying to come up with a way to bring all that back together and make sure that the patient is getting the most out of their experience.
One of the things we did was hire patient navigators to help patients navigate our system when they come to the health department. If a person has literacy issues or doesn’t understand all the services they can get when they come to a health department, it makes the process smoother if someone can engage them in the lobby and have that conversation before they get back to see a nurse or a family planning doctor for services. It helps a lot. A lot of times, when patients get back into those appointments, that’s when they want to ask many questions, which creates a backlog. Bringing patient navigators in and connecting patients to services like housing assistance, applying for SNAP benefits, food boxes, and those sorts of things in advance, and giving them points of contact, really helps. That helps the clinic.
What’s been the impact?
One of the things we noticed immediately was that we were able to double the number of patients we can see in a day. Being able to open up more appointments because we’re meeting more needs when patients come to the door, rather than when they get back for an appointment. A 15-minute immunization appointment can turn into a 45-minute conversation about how to get access to WIC, community health workers, or maybe even a question for an epidemiologist. Having that patient navigator in the lobby to address those questions, give out a business card, point to a flyer with a QR code, and show where health department updates are posted on the website — all of those navigation tools help us get through appointments on time, which allows us to open up more appointments.
Why is this work so important?
It’s very important to make sure the community knows that you’re doing what you need to do to provide them with the services they need. Being a public health organization, we want to be that safety net for the community. A lot of our clients and patients are underinsured, have low or no income, or live in impoverished situations, and take public transportation, ride bikes, or walk to health department locations. They often go a long way or face challenges to get to the health department, like finding a babysitter or taking time off from an hourly job, and when they’re not there, they’re not getting paid.
It’s very important for us not only to provide the services we offer, but also to make sure they maximize every minute they’re in the health department. Just because someone could take off from work for this visit, it doesn’t mean that in a month or two, the circumstances will be the same. We take that into account and really try to connect our patients to as many services and resources as we can.