Mickey Mouse idea
To streamline patient visits, local psychiatrist takes cue from Disneyland
Dr. Ron Risley is something of a mental-health crusader. Against a backdrop of county mental-health budget cuts and increasing patient caseloads, Risley saw a need to provide doctors and patients with a better way of interacting—one which would get both their needs met in a timely and cost-effective manner—and set about building a better mousetrap.
Risley, 51, said he saw a system in need in 2001, when he began working with Turning Point’s Homeless Intervention Program. A psychiatrist with a private practice, Risley is also contracted with TCORE—Transitional Community Opportunities for Recovery and Engagement—a Mental Health Services Act-funded mental-health program that provides wrap-around services to county mental-health clients coming out of jail psychiatric services or the county’s mental-health treatment center.
Both organizations faced a similar challenge, according to Risley: About half the time allocated for patients was used for clerical work—paperwork generated by doctors on the patients.
“For example, currently at TCORE, for a doctor to admit a patient, it takes 23 pieces of paper—and that’s not counting what the service coordinators or other staff has to do,” Risley said. “And I found that frustrating, because I could be spending time with patients instead.”
Opened in June 2007, TCORE currently serves about 750 clients—up from 300 when it opened, thanks to the influx of clients caused by budget cuts and the subsequent closure of the county’s regional support team offices. Thanks in part to Risley, TCORE has the distinction of being the only county program to offer clients same-day appointments, as well as implementing a computer program to streamline patient paperwork, which allows doctors to increase the amount of time spent with patients, according to officials there.
Both systems were designed and set up by Risley, who, in a former occupation, was a computer engineer.
“I think Dr. Risley’s programs are incredible and should be adopted by the county,” said Marlyn Sepulveda, TCORE program director, noting that consumer no-shows have dropped from an average countywide rate of 70 percent to around 5-9 percent. “It saves time for our doctors, our staff, better serves our consumers, and it’s free—which is amazing.”
Because appointments are often made three months in advance, patients forget, Sepulveda and Risley explained. Yet a doctor’s time is still blocked off, and other patients need to be seen. Patients who missed their appointments couldn’t just drop in under the old system, because there was no way to track who was in the office waiting to be seen and which doctors had openings in their schedules. With Risley’s new system, doctors and staff can view at a glance who has openings throughout the day, thereby allowing clients to be scheduled the same day if needed.
The county’s Department of Behavioral Health Services said it is studying Risley’s programs, which the psychiatrist developed and implemented on his own time.
“I got the idea from Disneyland’s Fastpass system,” said Risley, of his same-day-appointment scheduling program. “Physician productivity—time spent with patients—is about 60 percent countywide. At TCORE, it’s over 90 percent—because of the reduction in paperwork and because of the new scheduling system.”
The new system has its enthusiasts, like Sonny Cline, a physician’s assistant at TCORE, who said he’s been able to spend more time with patients now.
“I tell people now, ‘You’ve got access,’” said Cline. “You’ve got an access code now, and you can see me the next day if you need to. We’ve got 90-minute windows, and I can flip back and forth to see who’s waiting to be seen and how much time I’ve got. I’m rather passionate about this.
“With the old system, you’d have the frustration of having all these no-shows, while doctors are sitting around, and yet you’ve got all these other patients who are waiting six months for an appointment. It was nuts. Now you’ve got a 24-hour window for an appointment, people don’t forget and we’re seeing more patients. It’s a much better system,” Cline said.
Risley, who has sent copies of his programs to the county board of supervisors, hopes it can be used “somehow to streamline all the RSTs, so they won’t have to throw so many clients out of the system.
“Wherever we can reduce the cost yet improve quality of care, we should do it,” Risley continued. “And the result would be a better served citizenry.”
Added Cline, “This program is open-source, it’s free, there’s no reason this couldn’t be taken to all the RSTs—and it’s written by a doctor. I just don’t understand why we’re not using this all over, especially when we’re strapped.”