Michael Groff

When it comes to expanding access to clinical services, recruiting more providers is only one part of the equation. Since being appointed vice chair of Clinical Affairs in the Department of Neurosurgery just under a year ago, Michael Groff, MD, has focused intently on streamlining processes to strengthen the team’s responsiveness to patients, other caregivers in Brigham Health and referring physicians.

Groff, who also serves as director of the department’s Neurosurgical Spine Service, recently spoke with BWH Clinical & Research News about initiatives Neurosurgery has spearheaded over the past year to enable the team to better serve patients and referring providers.

What have your priorities been over the past year?

MG: The vision for this newly created role has been to help with real-time clinical issues and longer-term strategic planning in the clinical domain. I’ve been very focused on improving access for new and returning patients by managing our referrals with greater efficiency.

We want to be responsive to the physicians who are referring to us while also maximizing the patient experience – delivering the right care with the right provider in a timely manner.

What has changed from an operational perspective to achieve this?

MG: In the past, our approach was more reactive. If our department got a call about a patient needing an urgent clinic visit, there were times when we simply did not have the clinic space available to care for them. Now, we’re taking a much more proactive approach – continually keeping a close eye on referrals as they come into our department and making sure that access to our clinics is below the 14-day standard. Our wonderful new patient coordinators will reach out to our administrative assistants and make sure that they know where additional clinic visits can be added even before the patient calls.

While we did have some of these processes in place previously, we are delivering on them in a more formalized fashion so that everyone in our group knows what the expectations are. As our volume grows and our neurosurgical footprint expands geographically, this becomes increasingly important.

Can you provide an example of what this translates to in day-to-day clinical operations?

MG: We’ve encouraged our physicians to open up more clinic time whenever the need arises. To support this, we’ve empowered our physician extenders – nurse practitioners and physician assistants – to practice with greater independence. These are health care professionals that have been working with our physicians for a long time; for example, physician assistant Pam McColl, PA-C, and I have been working together for more than 10 years. So even when our physicians are tied up with a long case in the OR, patients can get the appointments they need scheduled in real time. I am very pleased that this emphasis on responding to patient needs in a very timely fashion has been implemented across our entire department.

Groff has been working with physician assistant Pamela McColl (right) for more than 10 years

What does this mean for how you manage referrals?

MG: Neurosurgery is very sub-specialized now. But until recently, referrals that came into our department would go to the on-call provider, who may or may not be specialized in that particular patient’s needs. For instance, if several spinal referrals came in when a brain tumor specialist was on call, it might take several days for the on-call provider to go through them and decide whether this is a patient they should see or something to refer to their colleagues.

We’ve managed to parse things out so that the brain tumor referrals are going into one bin when they come in and being vetted by those specialists, the spine referrals are going into another bin for review by the spine providers, and so on. That was the first step. Then, on the specialist side, we’ve also made sure it’s done in a well-defined way so that it doesn’t require physician review to get the patient an appointment.

Can you provide some more detail about that second change?

MG: In neurosurgery, particularly, some patients need to be seen urgently. We set up a new system in our call center to make sure we see those patients as soon as possible.

If a physician is already booked, you would need them to make some extra clinic time available. Our providers are more than willing to do this, but historically the process has been very manual. The request would go to the physician’s inbox and remain there until they saw it and could respond. But the provider might be tied up in the OR all day, so hours or possibly days could pass before they have the time to review the referral and free up additional clinic time to see this patient. What we’ve done is standardize this whole process and leverage our advanced practitioners to schedule appointments for our patients with a much quicker turnaround.

Now, when we receive an urgent neurosurgical referral without a request for a specific clinician, our call center can determine which provider has the earliest access and schedule the patient right away – without any action required by the physician. The administrators are authorized by each of our providers to open up clinic time, and our nurse practitioners and PAs work with the team to determine when it is appropriate to do so. All of this happens behind the scenes in near real time.

Looking ahead, what are your goals for the next year?

MG: Most of our referrals still take place by phone. E-referrals are a relatively small part of our referral volume, and I think that’s an area of our service in which we can grow. Whether it involves simply raising awareness about e-referrals or making the tool a little more user-friendly, that’s something we’re actively focused on and exploring. We are also starting a trial on virtual consults that looks to be very promising. There’s a common joke that neurosurgeons and rocket scientists often get wrapped up in technology; our department is committed to ensuring that the technology is always used in the service of getting the right care to the right patient at the right time.