Inside CoxHealth's 'Culture of Yes'

Patients need care that fits their schedules. Through teamwork and creativity, we are making that care a reality. 

How quickly can you get in to see a doctor?

In the health care world, it's common for everyone to accept that it may take a few months.

The problem is, our patients are in a world with instant access to all kinds of services. They live busy lives and they need care on their schedules.

At the spring Leadership Development Institute, Regional Services Vice President Max Buetow spelled out the situation at CoxHealth: On average it took three to seven months for new patients to get in with a provider.  

"That lit a fire for our clinics and providers," says Brock Shamel, administrative director. "We all own the fact that we allowed access to get to that point where it was. Patients want in – today.  

"We know that when you shut the door, patients will go elsewhere. We have to improve if we are going to be sustainable." 

To keep growing and thriving, CoxHealth has to have a culture of yes. Over the past few months, we have made great strides in making sure patients hear: "Yes, we can care for you, and we can do it now." 

If a new patient needs a primary care appointment, we can now see them in one or two days.  

"The doctors put themselves in our customers' shoes and they took ownership," Shamel says. "We can't hold back – to thrive for our patients, we have to do what's right." 

A team effort

To make the improvements happen, physicians and clinics have gone above and beyond to find creative ways to build in access. A few of the key tactics: 

Centralized scheduling

To smooth the process for our customers, providers allowed patients to be scheduled directly through 417-269-INFO. Patients can now make appointments and get expert guidance from the info line team with a single call. In the past, 16 providers offered info line scheduling, now 120 providers have appointments available. 

Online scheduling

In addition to the info line, a number of providers now offer online scheduling for new and established patients. Online scheduling is available for 75 providers. Shamel says that's up from just a handful of providers using the system in the past.  

"This is about making it as easy as possible – we don't want to be a burden to our customers," he says.  

Expansion of NPs and PAs

Clinics are now using nurse practitioners and physician assistants to help with new patient onboarding. In the past, mid-level providers worked primarily with established patients. Now patients receive what Shamel calls "team-based care." They may see a physician or they may see an NP, but they will be seen quickly.  

"A single-provider model won't meet patient expectations," Shamel says. "The environment has created expectations and we have to grow." 

Redesigned Welcome Clinic

CoxHealth's Welcome Clinic is now seeing follow-up visits for patients from the Urgent Care and Emergency Department. In the past, we worked to connect patients from the ED or Urgent Care with a primary care provider if they didn't have one. Frequently, patients didn't keep their first appointments with those providers. Now, the Welcome Clinic provides a better transition.  

"The Welcome Clinic is our landing zone," Shamel says. "They help patients find a great provider, based on their conditions or their location. It has been more successful than letting patients do it on their own." 

Performance improvement

The team is also pursuing performance improvement for the clinics. Six clinics are currently working to make processes more efficient. Shamel says the need is clear: if we are asking providers to see more patients, we need to make their workdays as smooth as possible.  

"We want to put the providers in a winnable position so they leave work at the end of the day knowing they accomplished their goals," he says.

Nurse Practitioner Dina Bieker and Dr. Mark Schultz collaborate on patient care at CoxHealth's Chesterfield Clinic. The Chesterfield team has expanded hours and is currently working on process improvement to care for more patients.

Growing the right way

CoxHealth Center Chesterfield, which had housed two providers, needed to grow. They knew they would be adding providers and leaders saw the growth as a chance to expand their patient-centered approach. 

In January, the clinic moved to a larger location and it now has seven providers – five physicians and two mid-level providers.  

The clinic uses creative scheduling, allowing for extended hours: 7 a.m.-7 p.m. and 8 a.m.-noon on Saturdays.  

"We surveyed a few clinics to see what hours patients would like," says clinic manager Leesa Wallace. "The prime time they needed is 4-6 p.m." 

Extended hours allow patients to come in before work or school or in the early evening.  

Wallace says new providers were hired with extended hours in mind, while staff have worked together to adjust their hours.

"It gives both patients and employees  options," she says. "Some people like to start early or leave early, others like to come in later." 

Six providers at the clinic are currently open to new patients. Wallace and clinic staff members work closely with the info line team to keep them informed of the availability.  

"Most new patients can be seen within one or two days, depending on what works for the patient," she says. "If we have a scheduling conflict and can't get them in, we work with the call center to find a clinic that can serve them best." 

In addition to new providers, the clinic also added additional staff members, including a triage nurse who handles incoming phone calls. This allows clinic staff to focus on patients in the clinic while freeing up front-desk personnel to work with patients as they arrive. 

For patients calling in, it means no waiting for a call back.  

"We want to think of ourselves as the patient," Wallace says. "We no longer make patients wait for responses or results. Their question may be something small or it may be life changing, but no one wants to be kept waiting." 

Wallace says the changes have made daily work better for clinic staff as well.  

"We hated when we couldn't get patients in – especially people who had moved to the area and need a doctor. Now, the clinic has exploded and we love it. We are doing what Steve Edwards asked. And we are helping patients. That's a great feeling."