Implementation of Telepsychiatry During the Covid-19 Pandemic
Challenge: As the coronavirus pandemic progressed toward a critical surge in Massachusetts, leaders of the department of Psychiatry at Cambridge Health Alliance recognized the urgency of continuing to care for patients remotely. Deploying Lean methodology, the department rapidly transformed all outpatient non-urgent mental health appointments to telemedicine within a span of five days. The system redesign process incorporated a customer-centric approach and continuous improvement through monitoring of operational data.
Results/Outcomes:
Without a preexisting telemedicine program or additional personnel, funding, devices, or platforms, we observed comparable visit volumes and a 48% reduction of no-shows.
When we compare a 5-week period before (February 9–March 14) to a 9-week period after (April 12–June 12) the transition, no-show rates decreased from a weekly average of 23% (SD 0.03) for in-person visits to a weekly average of 12% (SD 0.01) with telemedicine, including phone and video visits
Core Team: Executive & Psychiatry Leadership, IT, Schedulers, Patient Communications, Quality Department, Performance Improvement Team
Timeline: 5 Days
Day 1: Define
Project Kick-off/Alignment
Establishing a Team
Project Charter
Project Plan
Day 2: Measure
Conducting a Current State Assessment
Stakeholder Interviews
Current State Process Maps
Meet with IT to understand current platform
Day 3: Analyze
Accurate/Complete Data
Clarify Inconsistencies
Reimbursement Requirements
EPIC Visit Types
Day 4: Design and Improve
Root Cause Analysis
Impact-Effort Matrix
Action plan
Day 5: Implementation
Trainings (Schedulers and Providers) on Process
Develop FAQs
Send Patient Communications by language
Create Provider Hotline (for Technical Assistance)
Skills Used
Lean Six Sigma, Project Management, Excel, Powerpoint, Word, Data Analysis, Process Mapping, Root Cause Analysis, Reimbursement Implications, Stakeholder buy-in, Cause and Effect, Gemba Walk, etc.
