Using QA to Improve the Outreach Patient Experience

May-June 2014 - Vol. 3 No. 3 - Page #13

Quality Assurance is commonly defined as the maintenance of a desired level of quality in a service or product, especially by means of attention to every stage of the process of delivery or production. Within the clinical laboratory, we have historically focused quality assurance (QA) efforts on maintaining analytic quality and patient safety, improving turnaround times, or increasing departmental efficiency. Given the recent trends related to health care reform, hospital consolidation, and expected levels of service provision, fostering patient engagement and improving overall patient satisfaction have become priorities for most health care providers.

Value of a Systematic Approach
Taking a systematic quality viewpoint and focusing on sound change management activities, there are several ways to approach outreach in a positive way. Examples include the Institute for Healthcare Improvement’s Triple Aim,1 which uses a systematic approach to change by improving the patient experience of care, improving population health, and reducing the per capita cost of care, across a community of care. Furthermore, within the Medicare Shared Savings Program for Accountable Care Organizations (ACOs)—where quality performance is linked to reimbursement—the very first measure listed among the 33 CMS-initiated ACO quality measures is getting timely care, appointments, and information (see TABLE 1). While neither the IHI nor the CMS program initiatives contain measures that are specific to laboratory, as health systems continue to closely integrate providers and outpatient ancillary services, there are significant opportunities therein to enrich the patient’s experience with the laboratory, and to fold these opportunities into the overall adoption and impact of satisfaction rankings.

Click here to view a larger version of this Table

Program Aspects for Review
When taking the point of view of a patient seeking to access aspects of the laboratory outreach program, there are several important, qualitative points of contact that directly impact engagement and satisfaction, including the following: 

  • Access to information about the laboratory, its line of services, and its accessibility (advertising, print and, online resources)
  • The patient’s experience at the physical Patient Service Center (draw site), including phlebotomy
  • Access to test results, including timeliness and clarity
  • Satisfaction with fees and billing processes

As a routine part of ongoing improvement and quality assurance initiatives, the laboratory should evaluate its performance in each of these areas and seek opportunities for refinement. Keep in mind, for an outreach patient, the phlebotomy experience is usually the only face-to-face interaction that the patient has with the laboratory, thus, it is often the only laboratory activity by which patient satisfaction is gauged.

Fostering Patient Satisfaction
When a laboratory chooses to launch a quality assurance activity related to improving patient satisfaction with the outpatient phlebotomy process, there are several possible areas of focus. One area that many laboratories struggle with is managing wait times within the patient service center. A simple Internet search for the phrase common patient complaints leads to a series of articles on the deleterious impact of prolonged wait times on patient satisfaction. If patient behavior is consistent across each encounter within the health care system, one can assume there is a correlation between patient wait times and overall satisfaction with the laboratory. 

A tool commonly used to manage quality assurance projects is referred to as DMAIC. This acronym is further defined below, with examples specific to laboratory outreach programs and tips on reducing phlebotomy patient wait time: 

  • Define – The first step is to select a specific area of focus for the improvement project. For the patient, the laboratory patient service center encounter often involves other departments within the institution, such as scheduling or registration. Thus, it is not unusual to engage multiple departments in the initiative. 
  • Measure – Document current processes and establish a baseline of performance. Any improvements to the process will be measured against this baseline, so it is important to select data measurements that can be replicated once the new process is implemented. Often when we evaluate turnaround times within the laboratory, it is from an internal perspective. When evaluating patient wait times, it must be from the perspective of the patient, and not the laboratory. From the patient’s perspective, wait time equals episode time, encompassing the entire process from start to finish. This is described as the amount of time it takes from when the patient walks in the door of your patient service center until they walk out. 
  • Analyze – Identify the potential causes for the problem that the project is trying to resolve. For the example used here—reducing wait times—this step will involve flow-charting of processes and time studies. 
  • Improve – Redesign and implement process changes (including a beta phase), evaluate and refine prior to implementation. It is important to acknowledge the roles that employee training and buy-in have in the success of any improvement initiative. Change management often can be the most challenging aspect of implementing a new process. 
  • Control – Monitor data to sustain improvement efforts. In addition to hard data such as timing studies, it is important to also survey the patient directly regarding satisfaction. Since the initial intent of the project is to improve patient satisfaction, it will be necessary to correlate the impact that reduced wait times have on satisfaction. ConclusionQuality assurance plays a critical role in health care by maintaining and improving the quality of services and processes, which in turn enhance the delivery of care to our patients. As health care continues to evolve and payment models become more inclusive of patient satisfaction measures, it is vitally important for laboratory to focus on improving the patient experience. Because the laboratory is a critical element in the continuum of care, the outreach program provides a necessary mechanism to enhance the patient experience and provide strengthened relationships in the future.


  1. Institute for Healthcare Improvement. Initiatives; The Best Care for the Whole Population at the Lowest Cost. IHI Triple Aim Measures. Available at:
  2. Centers for Medicare & Medicaid Services. Shared Savings Program. Quality Measures and Performance Standards. Available

Jane Hermansen, MBA, MT(ASCP), is the network manager for Mayo Medical Laboratories in Rochester, Minnesota. She has over 25 years of clinical laboratory experience in both community hospital and academic medical center settings. Jane received a BA in medical technology from Concordia College in Moorhead, Minnesota, and an MBA from the New York Institute of Technology. Her experience includes clinical research, process engineering, project management, and laboratory outreach consulting, training, and facilitation.


Conference Announcement
Leveraging the Laboratory: Outreach Acceleration
September 24-25, 2014 • DoubleTree Hotel • Rochester, Minnesota

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