Best Practice Strategies for Maximizing Clinic Efficiency: Part 1 Missouri Family Planning Conference Webinar Series Elizabeth Jones, MPA June 15, 2017

Learning Objectives As a result of this session, participants will be able to: Examine the relationship between clinic efficiency and sustainability List best practices for improving clinic flow and staffing

Case Study Mar Vista Family Planning Agency is a freestanding Title X-funded health center that offers only family planning services. In 2015, Mar Vista's team of 8 FTE staff served 1,697 unduplicated patients and had 2,970 visits. This is an 8 percent decline from 2011. On-site staffing at Mar Vista is comprised of: 1.5 FTE nurse practitioners 0.5 FTE project administrator [one nurse practitioner does administration part-time] 1 medical technician / laboratory technician 2 front desk staff (one is trained to check in patients and answer phones; one to collect insurance and payment information) 2 health educators 1 biller

Polling Questions How would you describe Mar Vista Family Planning Agency’s Staffing? Understaffed Staffing is just right for patient volume Overstaffed Not sure

Rationale for Focusing on Clinic Efficiency

Doing more with less “The increased demand placed on public health organizations to perform better and improve health outcomes with less funding cannot be achieved under the design and operation of the current system.” Riley, J et. al. 2010. Realizing transformational change through improvement in public health. Journal Public Health Management Practice; 16 (1):72-78.

Enhancing the use of resources in order to achieve better outcomes What is efficiency? Enhancing the use of resources in order to achieve better outcomes

Efficient Use of Resources Why is creating efficiencies important? Increases productivity Improves sustainability Minimizes duplications of services Streamlines services Facilitates cross-training of staff to maximize skill sets Increases patient satisfaction Enhances staff accountability

Clinic Efficiency SUSTAINABILITY Increased capacity More patients served Improved patient access and experience

Workflow and Staffing Strategies

Workflow Workflow: “The systematic observation and analysis of the process or ‘flow’ of work and patients within a system and the rate at which patients complete a visit” Office of Population Affairs. 2012. Clinic Efficiency: A Compendium of Strategies and Recommendations for Title X Family Planning Programs. Washington, DC: Government Printing Office.

Workflow Examining workflow is beneficial because it: Looks at the “big picture” Can be measured Provides objective information Can serve as a catalyst for making improvements in a health care setting

Best Practices in Workflow Having visit cycle times where staff contact time is greater than patient waiting time Reducing hand-offs between staff (i.e., combining steps in the delivery of care) Bringing services to the patient Standardizing processes Cross-training and task shifting Modifying staff schedules (start, end, breaks) to when resources are needed Conducting staff huddles Office of Population Affairs. 2012. Clinic Efficiency: A Compendium of Strategies and Recommendations for Title X Family Planning Programs. Washington, DC: Government Printing Office.

Audience Question Have you sought to implement any best practices in workflow at your agency / health center site? If yes, please tell us about your experience!

Workflow Indicators Average cycle time Wait time The average amount of time (in minutes) that a patient spends at an office visit Benchmark: Depends on visit type, but the Institute for Healthcare Improvement (IHI) suggests taking the amount of time that a patient spends with the clinician and multiplying that by 1.5 Analyze by day / time, type of visit, and clinician Wait time The time a patient waits before being seen by medical staff Benchmark: 20 minutes or less Institute for Healthcare Improvement (IHI). 2017. Office Visit Cycle Time: Improving Primary Care Access; HIMSS Financial Systems. 2010. Revenue Cycle Management: A Life Cycle Approach for Performance Measurement and System Justification.

Workflow Indicators No-show rate Percentage of appointments for which patients did not show Benchmark: 4% Also… workflow analysis can produce valuable data Analyze time spent at each stop, bottle necks, and number of stops Medical Group Management Association (MGMA). 2011. Patient Wait Times, Optimal Panel Sizes, and Handling No Shows.

Staffing Staffing: The process of assigning individuals to fulfill all roles in a health care setting Staffing patterns are interrelated to the appointment schedule

Staffing: Utilization and Productivity Utilization: The proportion of the available time that a staff member is performing a specified task or service Example: Proportion of clinician time spent face-to-face with patients Productivity: The proportion of time staff are seeing patients during their available hours (with goal of maximizing the number of patients seen)

What to Consider: Staffing Did you hire for “right fit”? Hire for attitude  Train for skills Who is answering the phone, making appointments, registering patients? What is required during a patient visit? Who is required to provide specific services (i.e., scope of practice)? What staff can be cross-trained?

Staffing Indicators Support staff per FTE clinician The number of full-time staff members it takes to support one full-time clinician Benchmark: 4.67 support staff per FTE clinician Approximately 2.0 clinical support staff (e.g., RN, LPN, MA) per clinician Approximately 2.67 front desk and business support (e.g., biller, coder, fiscal staff) per clinician Reeves CS. 2002. How many staff members do you need? Family Practice Management; 9(8):45-49.

Staffing Indicators Clinician contact time Proportion of total clinician time spent in direct contact with patients Benchmark: There are no broad standards, but the American Academy of Family Practitioners uses a benchmark of 80% Also important to measure average clinician contact time Murray M, Davies M, Boushon B. 2007. Panel size: how many patients can one doctor manage? Family Practice Management; 44–51.

Best Practices in Staffing Knowing and communicating what is expected of staff: Right sizing Start and end times and breaks Visits per hour Contact time Tasks Triage What “busy” means MGMA. 2009. Lessons for Financial Success: Productivity, Capacity and Staffing.

Best Practices in Staffing Having staff do what they do best: Maximize utilization of expertise Reduce duplication Consider unique roles and contributions Have outcomes or goals for visits Having staff scheduling reflect patient demand MGMA. 2009. Lessons for Financial Success: Productivity, Capacity and Staffing.

Audience Question Have you sought to implement any best practices in staffing at your agency / health center site? If yes, please tell us about your experience!

Other Considerations Physical environment Team interaction Patient population What the customer wants MGMA. 2009. Lessons for Financial Success: Productivity, Capacity and Staffing.

Questions? Type questions on the panel to your right or raise your hand

Elizabeth Jones ejones@nfprha.org 202-251-2645 Thank you! Elizabeth Jones ejones@nfprha.org 202-251-2645