By Jimmy O’Keefe 

With locations stretching 300 miles across Virginia, about 1.2 million patient visits are scheduled at VCU Health each year. Team members in Ambulatory Operations try to make the process to get an appointment straightforward and seamless for the patient, prioritizing timely access to care.  

“Easy is what we’re trying to achieve,” said Jalana McCasland, vice president of Ambulatory Operations at VCU Health. “We want to make it easy for our patients to access us and easy for our providers and staff to access our patients or to provide care for patients.” 

However, the new year started off with a cascade of disruptions around the health system. The Richmond region experienced a massive water disruption, causing some ambulatory locations to close until water service could be restored. That meant appointments would need to be canceled and, eventually, rescheduled. 

“We knew pretty quickly that we were going to have to pivot and close because the number one job was to keep the hospital open and to reduce the strain on the system,” McCasland said.  

We can't just say, 'Okay, we’ll reschedule for next week.' Next week's already full. So is the next week. And the next week. So, there was a mad dash and scramble to figure out what's the best way to get these patients scheduled.

Brett McMillan, vice president of Revenue Cycle Operations at VCU Health

Roughly 20,000 ambulatory appointments needed to be rescheduled. Rescheduling that many appointments is a tremendous task, and far from easy. But thanks to the unrelenting resolve of team members in Ambulatory Operations and their partnership with the Revenue Cycle Operations team, all disrupted ambulatory appointments were put back on the schedule within weeks of the closures brought on by the water crisis. 

‘A mad dash’ to provide new appointments 

Communication played a key role in getting so many appointments rescheduled. Ambulatory Operations can communicate with patients about their appointments in a number of ways, including text messages, phone calls and patient portal messages. Because of the volume of appointments and the hectic pace of the situation, text messaging became a critical mode of communicating with patients about the status of their next visit with a VCU Health provider. 

"We were trying to do this instantaneous sort of communication with patients using text messaging, so every day we're closed again, we send out those messages,” McCasland said.  

But the weeks following the water disruption were already booked up, making it more challenging to reschedule.  

“We can't just say, 'Okay, we’ll reschedule for next week.' Next week's already full. So is the next week. And the next week. So, there was a mad dash and scramble to figure out what's the best way to get these patients scheduled,” said Brett McMillan, vice president of Revenue Cycle Operations at VCU Health. 

As VCU Health team members were rescheduling thousands of appointments, others were helping to distribute water to patients across the downtown academic medical center campus. (Tom Kojcsich, Enterprise Marketing and Communications)  

The answer? An innovation learned from the challenges VCU Health faced during the onset of the COVID-19 pandemic: telehealth.

“If you can't come in because we don't have water, just call me up on the video and we'll do a video visit,” said McMillan, describing the pivot from in-person to virtual appointments. 

The ability to convert patients to virtual visits helped cut down the number of appointments that would ultimately need to be rescheduled while minimizing disruption to patient care.  

Moving the chess pieces around the region 

Still, not every appointment set for the week of the water crisis could take place virtually. Where possible, ambulatory clinics with access to water took in additional patients. 

“We would start moving the chess pieces all over the region saying, 'okay, who's open? Who has water?’ And with provider and staff support, we moved clinics to other locations to minimize cancellations,” McCasland said.  

It was an all-hands-on deck effort that epitomized the team’s dedication to our patients.

Scott Stringer, M.D., president of MCV Physicians, the medical practice of VCU Health

MCV Physicians, the medical practice of VCU Health, played a crucial role in facilitating shifting appointment locations and the transition to telehealth.  

“MCV Physicians, Advanced Practice Providers and the entire administrative team worked in concert with ambulatory and Patient Appointment Center colleagues to prioritize patients for rescheduled appointments based on the risk of having significant medical problems. They opened extra slots and added additional clinics to get patients the care they needed as rapidly as possible,” said Scott Stringer, M.D., president of MCV Physicians. “It was an all-hands-on deck effort that epitomized the team’s dedication to our patients.” 

Once some patients had their appointments converted to telehealth and others visited a clinic with water service, efforts turned to rescheduling the remaining patients. Ambulatory Operations team members prioritized getting patients into clinics as Revenue Cycle Operations staff worked to find available time slots.  

“We went to teams that normally run through very rigid, very specific scheduling criteria, and we said, ‘hey, if you can find a spot, make it work to get the patients in and be seen,’" said Kyra Houck, associate vice president of patient access for VCU Health. “It was a great opportunity for outside-the-box thinking in the scheduling room.” 

Teamwork in action 

About two weeks after the end of the water disruption, all 20,000 impacted ambulatory appointments were rescheduled. Everyone involved in the rescheduling effort agreed that teamwork was the most important aspect in rescheduling so many appointments and that VCU Health’s commitment to safety, teamwork, accountability, relationships and service – referred to as STAR Service by team members – was on full display.

“Everybody working together was just really fantastic,” McCasland said.

“We saw great STAR Service from our team members that week. We saw tremendous engagement from them and a commitment to getting the patients taken care of,” Houck said. “I'm incredibly proud.” 

Meet the team who kept the water running at VCU Medical Center throughout a week-long outage

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