Where Does the Time Go? Results of Educator Time Studies

Judith Goodwin, MBA

Elaine Sullivan, MS, RN, CDE

Objectives

Describe benefits and methods of an educator time study

Define the educator role and best use of time Analyze data from sample educator time

studies to develop a CQI plan to improve efficiency

Where does the time go?

Do you feel like you run through your day? At the end of the day do you feel like you didn’t

get anything done? Does your manager have to justify your

productivity? Do you feel pressured to do more, but don’t seem

to know how? Let’s see if we can figure out what gets in the

way…

Educator Roles

Educator Clinician Coordinator Consultant Case Manager

Mensing C & Mulcahy K. The Role of the Diabetes Educator in the Management of Diabetes Mellitus in Goldstein BJ & Muller-Wieland D, eds. Textbook of Type 2 Diabetes. London: Martin Dunitz; 2003: 39-50.

Key Tasks to Fulfill the Role

Teach patients self-management of diabetes Help patients evaluate their self-management Encourage & support patient behavior change Update patients on new therapies/options Identify community resources for patients Educate PCPs & the community on the role of

the educator

Purpose of an Educator Time Study

Identify how you are spending your time Identify activities that impede your ability to see

patients Determine what activities can be eliminated or done

by less expensive personnel Acknowledge activities that support the

organization even if they impede the key tasks Discuss shifting cost of organization support to

appropriate departments

Data Tool: Educator Daily RecordScheduled work hours 8 Actual worked hrs 8.25 Date: 6/12/07

Time 1:1 Class Charting Phones Mtgs Clerical Inpatient MD support

8-9 30 30

9-10 60

10-11 60

11-12 30 30

12-1 45

1-2 30 30

2-3 60

3-4 60

4-5 30

Total 120 120 60 60 30 60 45

Educator Time Study Summary Sheet

Educ Total hrs

worked

1:1

Hrs

%

Group

Hrs

%

Direct

Care

Hrs

%

No show

Hrs

%

Charts

Hrs

%

Mtgs

Hrs

%

Phones

Hrs

%

Clerical

Hrs

%

Inpt

Hrs

%

Total

Process: Using the Data Tool

Get consensus on categories/definitions Pick a typical time period when educators not

on vacation or working on a major new project

Gather a week of data Keep your Daily Record as you go through

your day; don’t wait until the end of the day

Findings of 4 Educator Time Studies

Time Study Results - 2000

30 educators from 14 centers 1 week of data Average 8.8 hours worked/day

40% of time in direct patient care 14% Charting time 7% Phone time 5% Meeting time 27% time in “other”

Time Study Results - 2005

10 educators in 1 center 2 weeks of data Average 7.4 hours worked/day

30% of time in direct patient care 15% Charting time 7% Phone time 6% Meeting time 42% time in “other”

Time Study Results - 2006A

6 educators in 1 center 1 week Average 8.5 hours worked/day

30% time in direct patient care 25% Charting time 6% Phone time % Meeting time 23% time in “other”

Time Study Results – 2006B

7 educators in 1 center 2 weeks Average 8.7 hours worked per day

36% time in direct patient care including inpatient 14% Charting time 8% Phone time 15% Meeting time (combined 5 specific “other”) 3% time in unidentified “other” because 9

categories of specific “other”

One Site’s Attempt to Improve Measurement of “Other”

0

10

20

30

40

50

60

70

80

90

1st Qtr 2nd Qtr 3rd Qtr 4th Qtr

EastWestNorth

Group Total

4%

23%

8%

14%

8%

3%5%

8%

1%2% 3% 3% 1% 1%

6%3%

6%

Conclusions from 4 Time Studies

0%

10%

20%

30%

40%

50%

60%

70%

2000 2005 2006A 2006B

% o

f t

ime

% time in directpatient care

% time in specificsupport tasks

% time "other"

Conclusions from 4 Time Studies

Direct patient care 30 – 37% Charting 14 – 25% Phone time 6 - 8% Meetings 5 – 15% Other 3 – 42% Wide individual variance

Our Programs Need to Be Financially as Well as Clinically Successful

As educators our most important role is to be in front of patients educating

Some activities support that role Some activities get in the way We need to identify and eliminate activities

that get in the way of educating

If we only spend 30 – 37% of our time in direct/face to face/billable activities, we are not fulfilling our mission or assuring

our financial viability!

Good medicine is good business!

Joslin’s Goals and Assumptions for Financial Viability

60% of an educators day is spent face to face in billable encounters with patients

Groups are an effective and efficient way to increase financial viability

Decreasing “no shows” and cancellations is essential to clinical and financial success

Getting new patients in the door and bringing existing patients back is essential to clinical and financial success

Explaining the Gap Between Expectation and Reality

Educators tend to respond to everyone’s needs generously

We are used to giving away our expertise on the phone

In centers that include medical management we are frequently pulled to be physician extenders

Some PCPs give us their diabetes patients because of our expertise and we take on medical management of insulin by phone

Effective: Are we doing the right thing?

Efficient: Are we doing it the right way?

We need to nurture patient independence!

Tasks that May Support or Impede Role Depending on Time Spent

Charting/ documentation Phone calls Meetings Preparation for classes Orienting new hospital staff Email processing

Tasks that May Support or Impede RoleDepending on Time Spent

Driving to classes held in off-site locations Prescription refill support/clarification Professional development Marketing related activities PCP support Inpatient support Glucose log & CGM analysis

Tasks that could be done by less skilled staff

Clerical functions - finding charts, filing, making copies, ordering booklets/supplies

Scheduling appointments Calling/faxing referral sources for labs,

signatures, etc Tracking diabetes patient education outcomes Looking for missing medical records

Tasks that could be done by less skilled staff

Setting up room for classes Insurance verification Greeting and trouble-shooting “walk-in” visitors Phone triage Organizing diabetes walk (or other events) BG screening / meter downloading

Can we narrow our scope?

Are we willing to let go of anything? Can documentation be streamlined? Are we practicing medicine without a license? Should we consider hiring clerical help rather

than another educator? Do we limit/discourage patient access to us by

phone?

Can we narrow our scope?

Are we billing for all our services? Should inpatient responsibilities be in another

department’s budget? Are we getting more out of students than we

give? Are we successfully recruiting and using

volunteers?

Tabulate & Calculate: Educator Time Study Summary Sheet

Educ Total hrs

worked

1:1

Hrs

%

Group

Hrs

%

Direct

Care

Hrs

%

No show

Hrs

%

Charts

Hrs

%

Mtgs

Hrs

%

Phones

Hrs

%

Clerical

Hrs

%

Inpt

Hrs

%

RN 1 43 13 (30) 3 (7) 16 (37%)

4 (9) 10 (23) 4 (9) 6 (14) 7 (16)

RN 2 24 4 (17) 4 (17%) 1 (4) 2 (8) 2 (8) 2 (8) 13 (54)

RD 3 36 20 (55) 3 (8) 23 (64%)

2 (5) 4 (11) 2 (5) 4 (11) 3 (8)

Total 103 37(36) 6 (6) 43 (42%)

6 (6) 15 (14) 8 (8%) 12 (12) 12 (12) 13 (13)

Analyzing the Time Study: Individual Educators

Does your own scheduling template have 60% of your time available to see patients?

Is your personal schedule full? Are your DSMT visits in 30 minute increments? Are the other educators on your team more available to

see patients? What can you learn from them? If you are one of the most productive on your team, what

time management techniques can you teach the others? If you have administrative responsibilities, consider what

percent of your time is spent in those activities.

Analyzing the Time Study: The Team

If your team average is close to or over the goal, does individual productivity matter?

Is there a difference between part time and full time educators?

Do formal and informal team meetings and special projects take up too much time?

Is time spent marketing increasing your patient base?

Analyzing the Time Study: The Team

Is there a difference in how time is spent if the data is sorted by RN vs. RD?

Is your “no show”/cancellation rate acceptable? How would the results look if all “not typical”

days were removed? What can you learn from the range between

individuals in some of the categories?

Developing a CQI Plan

Identify the problem Collect data, tabulate, calculate and analyze Plan - discuss possible solutions Select something to try Act - implement change Evaluate the results Revise the plan

A Time study is only a tool in the CQI Process not the whole process!

Analysis and discussion are critical to using the data to improve your program

Select typical days/ weeks to do the study Decide together on definitions to avoid lots of “other” Set individual and team targets to increase direct

patient time and decrease “other” Collaborate with team and administration to develop

strategies to reach targets Set follow up time frame to repeat the time study

Another Example

4 educators in 1 center for 1 week Average 7.7 hrs/day worked

32% Time in direct patient care 6% Charting time 31% Phone time 7% Meeting time “Other” defined by team

10% Clerical 6% Chart search 2% Sales reps

Next Steps in CQI Process

Phone time is a problem!!! Who is precipitating calls? Patients/Families,

Educators, Physicians Are calls substituting for visits? What percent of calls are to cover for

endocrinologists in the practice? What percent of calls are necessary vs. nice?

Next steps in CQI Process

Define necessary calls Educate patients, physicians and each other

about necessary vs. nice calls Set goals to decrease phone time by a

specific percent for individuals and the team Re-measure and ???

Remember the time study is just the beginning of the CQI

process!

Send us your results -elaine.sullivan@joslin.harvard.edu