As is oftentimes the case when undertaking a large project for management, those (in this case myself) with hands on get a better feel for the processes involved on both a macro and micro level than does management who oversees the project. Management was under the impression that the questionnaire I created to screen patients would contribute drastically to reducing wait-time for patients to receive services, when in actuality the questionnaire will only help expedite one small portion of the overall process (as well as provide families with an alternative that could be more preferable, less costly than paying employees to answer phone calls, provides immediate and standardized feedback, and is accessible 24/7). Since my last update, I have been busy finishing up piloting and readying the questionnaire for launch. Although the questionnaire is still a main focus of this practicum, we have shifted focus to some other issues. 

At the most recent meeting, we discussed all potential obstacles that are currently impeding on our attempts to provide the best quality service to the patients at KKI. We have developed a list of variables that are within our control, for which we have some/limited control, and those variables for which we have no control over. How patients access our services initially is being addressed through the questionnaire, but overall this project has become a Continuous Quality Improvement/Total Quality Management technique driven project (and boy is it data driven!). I have spent weeks compiling a list of 200 patients from 2012-2015, with 15-20 pieces of data for each patient. I will be moving these data to SPSS shortly to begin conducting correlations and other analyses. We are now focusing our efforts on reducing the time it takes for the clinicians who evaluate patients to submit their notes. 

KKI has a 30 day mandate in which notes must be submitted after an evaluation. This 30 day mandate results in variable latency for note submission; some clinicians submit their notes in as little as a day (which is our eventual goal for everyone seeing as when you or I visit the doctors office we have information printed/ready for us to take home before we leave the appointment) while other clinicians are habitually late offenders who submit their notes 40-50 (10-20 days late) days after an evaluation. After a detailed lit review search, I found studies that aimed at reducing latency to note submissions and I have been adapting the previous research for implementation here. I collected baseline data from fiscal year 2014-2015 and broke it down by discipline (Medicine, Nutrition, Behavior Psychology, OT, and SLP) and further by individual clinician. Using these data I compiled a graph that depicts those clinicians who on average submit their notes late. Although the intervention we put in place should greatly help the late offenders, it should also help those who are better at submitting their notes in a short period of time. When the overall wait-time is upwards of 9 months from initial contact to admission for services, a 30 day or 1 month difference can really make all the difference, especially as drop-out rate has been shown to increase as a function of wait time. 

If you have ever been to the Clinics at places like Target, they use an iPad to gather patient information prior to the appointment and then the physician enters information at a computer. The proposed intervention will revolve around an electronic questionnaire that can be completed via iPad or computer that will be added to each and every evaluation room. The paper/pencil format that notes are currently completed on (and later transcribed) will hopefully decrease the amount of effort exerted by the clinicians (since they will have to write their notes once instead of by paper/pencil and then transcribed). We hope to add drop down menus and select all that apply questions wherein the clinician will simply click to enter information. I am meeting with representatives from a few different companies this and next week to discuss their offerings and will hopefully decide on a host before my next update. 

Sorry for the long-winded update. I hope it was easy enough to follow, but please feel free to ask questions or provide your input. It is greatly appreciated.

Kevin Jones




Previous Update:
This summer I am completing a practicum at the Kennedy Krieger Institute. Thus far, I have met with management and continued the planning process for the project they have asked me to complete. I have created an online questionnaire using Qualtrics that screens patients in or out of our program, and from there it screens patients into one of two services. 

Following the completion of the questionnaire, patients (their families) are asked to complete a feedback survey so I can find out about their experience. I have sent the questionnaire to 65 families and have 22 responses as of this morning. I am getting some very useful feedback from families, for instance, I have found that the wording of one question in particular is troublesome and has led to patients screening themselves out of services. This should not be happening, as the 65 families I have sent the questionnaire have all received services at the Kennedy Krieger Institute in the past or they will in the near future. 

I have also included some usability ratings with Likert-like scales. At this point, there are resounding positive reviews. When I reach between 30 and 50 responses, I will discontinue piloting the questionnaire and post it to the institutes website, where it will be active, which will hopefully be by my next update.