Enhancing Clinic Efficiency

Presented by: Shelley Miller, MS Male Training Center Family Planning Council Philadelphia, PA

Disclosure I, Shelley Miller have no real or perceived vested interests that relate to this presentation nor do I have any relationships with pharmaceutical companies, biomedical devise manufacturers, and/or other corporations whose products or services are related to pertinent therapeutic areas.

ObjectivesAs a result of this workshop, participants will be able to:Identify techniques to assess clinic efficiencyIdentify common challenges to male service integrationDescribe strategies to improve efficiency of their clinic

A trip to Disney

Group Activity

DiscussSimilarities .Differences .

between your health center and Disneys

Capacity & Demand

Capacity & DemandCapacity is the sum total of an organizations resources, processes and underlying values that collectively respond to the needs of a patient population; it measures provider and service availabilityNumber of exam roomsHours of operationNumber of staffSkill mix of staffClinical Policies and Procedures

Capacity & DemandDemand is the total patient request for care

Requests for VisitsNumber of VisitsTypes of Care (visit types)Duration of visits

Shaping Capacity & DemandMatch Resources with Predicable Variations in Demand: Hours of operations, staff scheduling and breaks

Remove Internally Generated Variation in Demand: Limiting Service Availability and Cross Training

Limited Appointment Types and Standardized Appointment Lengths: Appointment Scheduling Practices

Maximize Staff Utilization: Maximizing staff expertise, staff skill mix, cross training and re-training

Evidence-based Clinical and Counseling Practices: Clinical policies and protocols, flexibility in provision of clinical care provided by new and emerging best practices

Measure DemandN = the # of unduplicated clients in a yearA = the # of client office visits during the year T = the # of sessions (days) during the yearP = the % of clients seen each day, A/(N*T)

Estimated Daily Demand = the percent of clients seen each day times (x) the number of clients per year

Measure CapacityClinician Visits:N = # of Clinician hours available to serve per yearV = # of Clinician visits per hourT = Total # of available hours X number of visits per hour

Assess: Does your Capacity meet your Demand?

Tools for Use to Access Clinic OperationsSWOT (subjective)StrengthsWeaknessesOpportunitiesThreatsPFA (Objective)Tracking sheetsMappingFPAR data

SWOT

SWOT ANALYSISStrengths of Agency in Clinic EfficiencyWeaknesses of Agency in Clinic Efficiency. Opportunities for Improving Clinic EfficiencyThreats by Improving Clinic Efficiency

Purpose of PFA

Provide objective informationLooks at big pictureCatalyst for making improvements in the clinicImprove customer serviceImprove staff moral by creating a team effort

PFA Output: ReportsSummaryReport 1: Clients compliance with appointmentReport 2: Clients time in clinicReport 3: Clients waiting timeReport 4: Personnel statisticsReport 5: Personnel time by client served by task codeReport 6: Personnel time by client served by visit codeReport 7: Personnel costsReport 8: Individual staff dataReport 9: Clients per hour by staff memberReport 10: Client contact sequence frequencyReport 11: User-defined dataGraph 1: Client time-lineGraph 2: Staff time-line

What PFA Does Identify

Show ratesClient time in the clinic and with staffWaiting time between stops (i.e. bottlenecks)Lost clientsStaff time available and service timeTime clients spend at each stopPersonnel costsVisit types

Overview of PFA ProcessPlan the studyHold a staff orientationCollect the dataPerform data entryAnalyze the resultsImplement changesPlan the (follow-up) study

To Access WinPFAGoogle: CDC WinPFA

Tracking Sheets, Mapping & FPARTracking/Routing Sheets Follows client through clinic visits from time walking in the clinic to leaving the clinicIdentifies each visit stop

Mapping: Identify clinic flow and how a client moves through the clinic

FPAR: Family Planning Annual Report

Implementing Change

Dont

Things you will want to considerAgency CultureNo ShowsWaiting times (for clients while in clinic)Appointment systemsCycle timeBottlenecksStaff Utilization and ProductivityFiscalEvidence Based PracticeOther ???: ___________________

Agency CultureSelf CarePhysical environmentManaging overloadTeam workCustomer Service

Agency Culture: Burnout When you hear yourself using I dont care

Agency Culture: Setting Healthy BoundariesLearning how to say no or not right now is one of the best ways to set limits, work efficiently and avoid burnout.

Agency Culture: Customer ServiceHire the right fitHire for attitude Train for skillsHealth care is a business NOT social serviceConsider retail experienceProblem solving ability Know what BUSY meansACT like they enjoy the job

Agency Culture:Customer Service Staff AttitudeAttendanceSmile CourteousUnderstand consumer needsMeet client needsWork as a teamPractice the golden rule internally & externallyThank the customerAddress issues of cultural competence

Staff Utilization: Managing OverloadWho is answering the phone, making appointments, greeting clients, registering and billing ?What is required during a patient visit?Who is required to provide the service?Cross-training

No Shows

List ways to responds to high no-show rate:

Waiting time

List ways to improve client wait time

How is your Appointment System Working?

Appointment Systems - TipsAnswer phones Monday amOffer walk-in or open access appts.Give client preferred timeUse delayed pelvisEvening & Saturday have best show ratesDifferentiate clinician visit vs. non-clinician visitFriday afternoon (3-6) best for supply pick-ups

Appointment Systems:10 Minute Method (clinic dependent)10 minute increments instead of 15 minutesNew appointment 20 minutesAnnual 10 minutesRepap 10 minutesPID: 20 30 minutesUTI: 20 minutes

Appointment Systems: Double BookingUse when high no-show rateBook 2 different types of appointments (i.e. new appointment and depo)Every once in a while . Everyone will show up, work as a team; if it starts to become a trend, reassess the schedule

Appointment Systems:Modified Wave3 clients scheduled on the hour2 clients scheduled 20 minutes past1 client scheduled 40 minutes pastPlays the averagesNot good with limited exam roomsMay not work for all types of services

Appointment systems:Back Fill MethodClients are told their appointment is x minutes prior to when they are expected to be seen by service staff. x minutes allows for paper work.

i.e. - For new clients may be told to come at 8:40, will be seen by provider at 9:00

Appointment Systems: Walk-inUse when clinic has high no-show rateTwo tiered numbering system for long/short visitsOn first come first served basisCap number of clients seem during a session

Appointment Systems:Open AccessUse when clinic has high no-show rateDevelop an appointment systemDetermine # of appointments that can be made in advanceClients may call up to 1-2 days in advance for appointments

Characteristics of Open AccessDo todays work today.Keep it simpleModel variations- open schedule# days% appts kept open for same dayMinimize appointment types and lengthsAppointments scheduled by availability, not typeDemand/capacity balance

Anticipated Benefits whyDecreased wait time for appt.Increased show rateIncreased productivity- increased client contact timeImproved continuity of careImproved client careImproved client satisfactionImproved staff satisfactionIncreased revenues

Getting Started with Open AccessResearching Open AccessImplementation teamTeam and Staff MeetingsImplementationResources

Implementing Open AccessCommit to a start dateClear backlog of appointmentRestructure appointment schedulesReduce demand for future unnecessary visitsRevise clinic processesInform clients and staffDeveloping monitoring systemDevelop contingency plans

Scheduling Male: Things to think aboutIntegrated clinic hoursMale services clinic hoursDay/evening/SaturdaysAre staff cross-trained or are hours to see males limited?Seeing males when they come in with partners

Evidence Based PracticeDo only what is evidence-based: work within current clinical guidelines (i.e. Quick start)

Reduce or eliminate unnecessary practices that can limit clinic efficiency and are not recommended (i.e. Paps in teens)

Use the most efficient means for clinical practice (i.e. integrating HIV testing)

Develop an Action Plan

Action PlanningIdentify what worked wellIdentify challengesBrainstorm ideasIdentify solutions that may workImplement changesMeasure success

Planning = SuccessStrong Planning will result in a long-term project able to sustain itself.

Evaluation & plan modification through stakeholders meetings is helping to sustain the project

Questions and Evaluation??

Contact InformationShelley Miller215 985-2645shelley@familyplanning.org