2016, Utah’s University Orthopaedic Center and Dr. Joy English opened a walk-in service, the Orthopaedic Injury Clinic (OIC) . Before the OIC, patients with non-life-threatening injuries would go to the Emergency Department or wait days, even weeks, for care, sometimes receiving an incorrect diagnosis. The OIC ensures that patients get the right diagnosis when they need it from the right provider—an orthopaedic specialist.
Improving value in health care means designing around patient needs. What if designing around patient needs felt like an energizing creative challenge? It did for Joy English. She tells Nick McGregor and Accelerate's Mari Ransco how designing urgent specialty care delivered meaningful work for her and improved care for patients.
Meaningful work is just plain fun
I find this work fun. I feel like I’m making a difference. There’s something rewarding about feeling needed. A big part of what physicians do is ego-driven (in a positive way). The ability to figure out challenging things and help people is extremely fulfilling.
Every case is different in the OIC, and I find that variety more interesting. Our care extends beyond “is it broken?” We look for muscle, tendon, joint, vessel, or nerve damage. I schedule MRIs and call the patient myself with results. I schedule follow-ups—about 75% of my patients are return patients I first saw in OIC. Those follow-ups close the loop for patients (and me) in a unique way. I get to see them through their recovery from injury.
My interest in orthopaedic injury is directly linked to my past as an athlete and my training in both sports medicine and emergency medicine. After my fellowship at University of Utah, I helped to open an acute care injury clinic at Washington University. I wanted to come back to Utah, and I thought Utah could really benefit from the same model. I emailed Ryan VanderWerff and said, “Here’s what I do, here’s why Utah needs it, and here’s why I think it would be good for patients.”
The Value Equation of Same-Day Specialty Care
Patients have a sense of relief when they are given an answer. Many of our patients are referred here after a visit to urgent care or the ED. I’m told frequently, “I just wanted an answer, and when nobody could see me, you saw me.” Injuries are emotional, and patients are thankful for a clear, concise diagnosis. My team makes them comfortable, treats their pain, and establishes follow-up care in a timely manner. Patients walk out with an understanding of the next steps. If a patient needs further evaluation by a surgeon, they are fast-tracked to the appropriate surgeon.
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Our monthly volumes have grown substantially—seven times since the clinic’s six-month mark of being open—to more than 200 patients per month. Patients love the flexibility of coming in after work hours when they want.
We will see everyone, no matter what time they show up. If 15 people are waiting when the doors open at 4:00 PM, it might take three hours to see everyone; if 25 people show up at 8:00 PM, every patient will eventually receive an examination. No matter what, we provide realistic wait times. Patients choose if they want to wait. It’s good for everyone—patients and staff—to set realistic expectations.
It takes a different kind of person to work evenings, though. OIC’s 4:00 - 8:00 PM evening shift can be a tough sell for other providers and support staff. But I love it. It’s quiet and I find the cases really interesting.
Continuity of care is powerful (and so is our culture)
For the patient, what is important is what happens after the visit. How clear is the information we provide? How quickly can we see them again? These are deciding factors in a patient’s decision to come back if they get injured in the future. It’s important for patients to have that continuity of care. If we succeed at that, we can maintain their trust and their emotional connection with the care they receive.
Also, our culture is unique. In specialty care, working in a clinic is often considered “less prestigious”—but not here. The surgeons at UOC recognize that non-surgeons have a unique skill set. We’re not viewed as less than; instead, we’re viewed as the same but with different skills. What we do is not urgent care or triage—I actually give people the exact same evaluation I would during a regular appointment.
Voice of the patient
For the last three years, Joy English has ranked in the 99th percentile for patient experience—the top 1% of academic physicians nationwide. The following two comments reflect the care delivered by the Orthopaedic Injury Clinic. Patients value the clinic's efficiency, care, and teamwork (three of University of Utah Health’s 5 Elements of Patient Experience). The clinic made it easy for the patient to get the care they needed. Joy English understood the problem and coordinated with other providers.
"Paige is amazing! Dr. English cares about her patients so much. Instead of saying ‘well we can't figure out what's wrong so you'll have to learn to deal with the pain’ she says 'we will find out what's going on with other tests, work together as a team because no one deserves to live in pain'. That's a great doctor! they took me in immediately since the dermatology sent me over the same day."— March 5, 2018
Above patient comments were collected on Press Ganey medical practice surveys, accessed for this article in June 2018.