Spotlight on: Nicholas Mollanazar
Assistant Professor of Clinical Dermatology
Director of Patient Access, Dermatology
Assistant Professor of Clinical Dermatology, University of Pennsylvania Perelman School of Medicine
Director of Patient Access, University of Pennsylvania Department of Dermatology
What is a practice to do when demand for medical care is high, but providers and clinic space are limited? Nicholas Mollanazar, an assistant professor and dermatologist at Penn Medicine, has been methodically tackling this conundrum, spearheading operational and technological solutions to enhance access to care.
A dominant feature of the access landscape is appointment scheduling. Mollanazar initially got involved with scheduling improvement efforts because of his leadership on Dermatology’s electronic health record (EHR) governance committee: Scheduling errors were cropping up in the EHR, and he wanted to locate their source. After shadowing an agent at the Access Center – Penn Medicine’s call center – Mollanazar and his colleagues discovered how manual and complex the scheduling process was.
To create a more automated and user-friendly experience, they developed an EHR-integrated decision tree for Dermatology that guides agents through a series of questions and supplies appropriate slots for scheduling.
“In the first six months after going live with the decision tree, errors were few and far between. The errors we did identify often came back to the tree, which we would then fix,” Mollanazar says. The tree required minimal training for agents to use, and the strengthened partnership with the Access Center allowed dermatology staff to focus on clinical operations. “It lets everyone operate at their highest license.”
From there, Mollanazar shifted focus to other pressing scheduling issues, namely the lack of available slots for new dermatology patients. But before he could test solutions, he recognized that he needed to learn more about the space and patient experience.
“So, I did something other people might not do,” says Mollanazar. “I pretended to be a new patient and called to make appointments. And I was told there are no new appointment slots. I had my mom do it, and then my aunt, and then my partner.” Through those calls, he confirmed that new patients were being scheduled a year out or simply turned away.
“We had to change our foundational understanding of access and scheduling. The first step was admitting to ourselves that we cannot see every patient calling – we don’t have the doctors or the rooms to do it.”
Given the resource limitations, the dermatology department decided to prioritize the most medically severe cases, where they believed they could have the highest impact, in the scheduling process. Mollanazar’s work also led the department to enact other changes: They made appointments for return and new patient visits (NPVs) the same length so that unfilled return visit slots could be converted to NPVs, reserved protected blocks for NPVs, and leveraged Switchboard’s campaign function to send patients multiple appointment reminders and offer easy cancellation.
These interventions substantially improved appointment utilization, including drops in no-show rates and late cancellations.
During the height of the COVID-19 pandemic, Mollanazar also collaborated on Penn Preview, a text message-based, automated program that guides dermatology patients and facilitates photo collection ahead of virtual visits. Penn Preview increased photo submissions by 31 percentage points, led to more high-quality submissions, and reduced clinician burden.
“Nicholas is relentlessly enthusiastic and deeply committed to improving clinical care and patient access in Dermatology and across the Clinical Practices of the University of Pennsylvania,” says Cynthia Morrisey, chief operations officer of Dermatology. “He challenges the status quo while collaborating with key stakeholders to pilot innovative ideas and analyze the results for effectiveness and scalability. Nicholas has helped to transform how we think about access in our department, and his positive energy is contagious.”
"Nicholas has helped to transform how we think about access in our department." – Cynthia Morrisey
Persistence is a leitmotif across Mollanazar’s endeavors. On many occasions, he has faced resistance, and learning how to manage that pushback has been important in moving ideas forward.
“I’m very eager to break things and try new things. Change is exciting to me,” he says. “Most people don’t view change that way – it scares them or puts them off. That was a big learning curve for me. I realized you have to get everyone on the same page, or nothing will get done.”
Part of that is getting stakeholders to understand where practice diverges from policy, Mollanazar says. “You can’t accept things at face value. You must observe how things actually happen to understand problems and design effective solutions.” When undertaking a critical review, he’s found that clarifying that it’s a process is under scrutiny, not an employee’s performance, eases resistance.
Collaboration has been essential, he says. “Central to the success of the decision tree was that we worked closely with Operations, the Access Center, and our admins, practice managers, and leadership to get it implemented.” Buy-in from leadership was particularly important for making more controversial changes like standardizing visit length.
Though they are many, Mollanazar’s administrative duties account for less than half of his work week. The rest of his time is spent treating patients for a wide range of skin conditions.
Being busy clinically, he says, allows him to observe firsthand whether and how things are working. That insight informs his other efforts, including his work as an informatics specialist building EHR tools to help providers be more efficient.
Looking ahead, Mollanazar is keen to explore an asynchronous model of care known as store-and-forward visits. In this model, new patients who opt in would provide information about their condition, including photos, through the myPennMedicine portal. Later, a provider would review the materials and develop a treatment plan.
“It takes away the video visit or chatting face-to-face. But that might not be necessary for all cases,” he says. “This would allow us to help more people. It would let us catch skin cancers faster and get people with more minor problems on treatment at higher and faster rates. When someone with a minor issue is told there is a two-month wait for an appointment, they often say forget about it. So this is an innovative project I’m really excited for.”