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.

Objectives As a result of this workshop, participants will be able to: Identify techniques to assess clinic efficiency Identify common challenges to male service integration Describe strategies to improve efficiency of their clinic

A trip to Disney

Group Activity Discuss Similarities …. Differences …. … between your health center and Disneys

Capacity & Demand

Capacity 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 availability Number of exam rooms Hours of operation Number of staff Skill mix of staff Clinical Policies and Procedures

Capacity & Demand Demand is the total patient request for care Requests for Visits Number of Visits Types of Care (visit types) Duration of visits

Shaping Capacity & Demand Match 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 Demand N = the # of unduplicated clients in a year A = the # of client office visits during the year T = the # of sessions (days) during the year P = 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 Capacity Clinician Visits: N = # of Clinician hours available to serve per year V = # of Clinician visits per hour T = Total # of available hours X number of visits per hour

Assess: Does your Capacity meet your Demand?

Tools for Use to Access Clinic Operations SWOT (subjective) Strengths Weaknesses Opportunities Threats PFA (Objective) Tracking sheets Mapping FPAR data

SWOT SWOT ANALYSIS Strengths of Agency in Clinic Efficiency Weaknesses of Agency in Clinic Efficiency. Opportunities for Improving Clinic EfficiencyThreats by Improving Clinic Efficiency

Purpose of PFA Provide objective information Looks at big picture Catalyst for making improvements in the clinic Improve customer service Improve staff moral – by creating a team effort

PFA Output: Reports Summary Report 1: Clients compliance with appointment Report 2: Clients time in clinic Report 3: Clients waiting time Report 4: Personnel statistics Report 5: Personnel time by client served by task code Report 6: Personnel time by client served by visit code Report 7: Personnel costs Report 8: Individual staff data Report 9: Clients per hour by staff member Report 10: Client contact sequence frequency Report 11: User-defined data Graph 1: Client time-line Graph 2: Staff time-line

What PFA Does Identify Show rates Client time in the clinic and with staff Waiting time between stops (i.e. bottlenecks) Lost clients Staff time available and service time Time clients spend at each stop Personnel costs Visit types

Overview of PFA Process 1. Plan the study 2. Hold a staff orientation 3. Collect the data 4. Perform data entry 5. Analyze the results 6. Implement changes 7. Plan the (follow-up) study

To Access WinPFA Google: CDC WinPFA

Tracking Sheets, Mapping & FPAR Tracking/Routing Sheets Follows client through clinic visits from time walking in the clinic to leaving the clinic Identifies 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 consider Agency Culture No Shows Waiting times (for clients while in clinic) Appointment systems Cycle time Bottlenecks Staff Utilization and Productivity Fiscal Evidence Based Practice Other ???: ___________________

Agency Culture Self Care Physical environment Managing overload Team work Customer Service

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

Agency Culture: Setting Healthy Boundaries Learning 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 Service Hire the right fit Hire for attitude Train for skills Health care is a business – NOT social service Consider retail experience Problem solving ability Know what BUSY means ACT like they enjoy the job

Agency Culture: Customer Service – Staff Attitude Attendance Smile Courteous Understand consumer needs Meet client needs Work as a team Practice the golden rule – internally & externally Thank the customer Address issues of cultural competence

Staff Utilization: Managing Overload Who 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 - Tips Answer phones Monday am Offer walk-in or open access appts. Give client preferred time Use delayed pelvis Evening & Saturday have best show rates Differentiate clinician visit vs. non-clinician visit Friday afternoon (3-6) best for supply pick-ups

Appointment Systems: 10 Minute Method (clinic dependent) 10 minute increments instead of 15 minutes New appointment – 20 minutes Annual 10 minutes Repap – 10 minutes PID: 20 – 30 minutes UTI: 20 minutes

Appointment Systems: Double Booking Use when high no-show rate Book 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 Wave 3 clients scheduled on the hour 2 clients scheduled 20 minutes past 1 client scheduled 40 minutes past Plays the averages Not good with limited exam rooms May not work for all types of services

Appointment systems: Back Fill Method Clients 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-in Use when clinic has high no-show rate Two tiered numbering system for long/short visits On first come first served basis Cap number of clients seem during a session

Appointment Systems: Open Access Use when clinic has high no-show rate Develop an appointment system Determine # of appointments that can be made in advance Clients may call up to 1-2 days in advance for appointments

Characteristics of Open Access Do todays work today. Keep it simple Model variations- open schedule # days % appts kept open for same day Minimize appointment types and lengths Appointments scheduled by availability, not type Demand/capacity balance

Anticipated Benefits … why Decreased wait time for appt. Increased show rate Increased productivity- increased client contact time Improved continuity of care Improved client care Improved client satisfaction Improved staff satisfaction Increased revenues

Getting Started with Open Access Researching Open Access Implementation team Team and Staff Meetings Implementation Resources

Implementing Open Access Commit to a start date Clear backlog of appointment Restructure appointment schedules Reduce demand for future unnecessary visits Revise clinic processes Inform clients and staff Developing monitoring system Develop contingency plans

Scheduling Male: Things to think about Integrated clinic hours Male services clinic hours Day/evening/Saturdays Are staff cross-trained or are hours to see males limited? Seeing males when they come in with partners

Evidence Based Practice Do 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 Planning Identify what worked well Identify challenges Brainstorm ideas Identify solutions that may work Implement changes Measure success

Planning = Success Strong 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 Information Shelley Miller