Improved Filing System Reduces Patient Wait Time at Laudium Clinic
Enhancing patient-centered care doesn’t always require technological innovations like SMS messaging systems or web-based applications. Sometimes, improving patient care starts with something as banal as…filing. Consider this: in many public health clinics in South Africa, a patient can routinely wait up to four hours at the facility just to have his or her file retrieved by the clerks – and this is before ever being seen by a clinician.
These huge delays turn routine clinic visits into all-day commitments requiring time away from work, school, or childcare duties and can make people simply forego important medical checks. In a country like South Africa, which bears one of the highest HIV burdens on the planet, getting and keeping people in care is critical to ending the epidemic, so every minute counts.
As the country pushes tirelessly toward UNAIDS’ 90-90-90 goals (by 2020, 90 percent of those living with HIV will be aware of their status, 90 percent of those aware of their status will receive sustained treatment, and 90 percent of those on treatment will achieve viral suppression) and epidemic control, “Siyenza,” a new initiative pioneered by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), is helping South Africa to find innovative solutions to some of these nagging problems and to improve health care – with patient outcomes front and center. When PEPFAR and the National Department of Health (NDoH) rolled out Siyenza in early 2019, improved file retrieval – the starting point for a patient’s interactions with a health facility – was at the top of the list.
Collaboration Leads to Innovation – and Success
This is where Brian Sway, a Peace Corps Response Volunteer serving in South Africa, came in. As a longtime business-process reengineering professional, Sway has decades of experience in automating business practices, bringing information technology to the table, dealing with records management, and guiding organizations in change management. He led a team of CDC staff in the development of a Standard Operating Procedure (SOP) and supporting tools to facilitate a reengineering of clinical records-management processes in public-sector health clinics. His SOP uses a structured and repeatable approach that can be adopted by large and small clinics alike.
Sway collaborated with CDC South Africa’s implementing partners as well as other key players. The process required constant adaption of frameworks, skills, and knowledge from one culture to another, notes CDC South Africa Country Director Amy Herman-Roloff. “He took this one step further – his focus was not only on doing the task at hand, but rather ensuring the sustainability thereof by being a teacher,” Herman-Roloff says. “Not only did he and the team adapt to South African needs, they were also trying to develop South African capacity.”
The results he was able to demonstrate were so dramatic that the SOP was shared with approximately 350 clinics across South Africa and adopted by NDoH. This Clinical Records Management File Clean-up SOP has now been implemented on a national scale. In clinics that have implemented the SOP, the time taken to retrieve a patient’s record has been reduced from more than three and a half hours to less than five minutes. These remarkable changes have resulted in overall patient waiting times being reduced by 70 percent. Clinics are therefore able to treat more patients and provide an improved quality of care. Patients who once waited up to eight hours to see a clinician now experience average wait times of just one hour and 15 minutes.
A Case Study: Laudium Health Centre
Laudium Community Health Centre, located in the City of Tshwane (not far from Pretoria), serves a large and diverse catchment area. The sheer volume of people coming to the facility coupled with an inefficient filing system had for many years resulted in frustrating bottlenecks and extremely long wait times for patients. Not surprisingly, this system left patients so frustrated that they often simply ignored their treatment plans and medical appointments rather than spend an entire day at the clinic.
That began to change when Wits RHI, a PEPFAR-supported, CDC implementing partner, started working closely with Laudium’s administrators to implement an overhaul of the facility’s inefficient filing system. The resulting, innovative system now enables clerks to retrieve patient files within 15 minutes of their arrival at the facility. This greatly improved system has seen patient waiting times to meet with a clinician reduced significantly – from a whopping four hours to just one on average. Hoping to further reduce this wait time, Sister Nancy Nkopane, Laudium’s Facility Manager, notes, “Although we are proud of how far we have come, we realize that there is still more work to be done.”
For their part, however, patients are taking notice of the improvements already made. “I have been coming to the clinic since 2011, and, in the past, they would sometimes not be able to retrieve my file at all. But in my last two visits, my file was retrieved within 10 minutes,” said Stanley, a patient who comes every three months to receive treatment. “I don’t know how they did it, but service has improved greatly – I hope they keep it up.”
It is small improvements with big impact such as this that are defining South Africa’s Siyenza initiative. CDC and other PEPFAR partners, working hand-in-hand with NDoH, are committed to continuing these sometimes simple innovations that are laser-focused both on patient-centered care and ending the country’s devastating HIV epidemic.