SFGH Children’s Health Center Quarterly Report, June 2011 CHC Stats 12,700 patients 16,000 primary care visits annually Provider FTE NPs: 2.24 FTE MDs: 1.73 FTE Residents: 1.89 FTE MEA/LVN FTE 4.0 MEAs + as needed 4.5 RNs 3 LVNs (1 currently on leave) 2 clerks and 1 senior clerk We have 7.6 FTE and need FTE! The Children’s Health Fairies Lannie Adelman, RN, MS, MBA Shonul Jain, MD Shannon Thyne, MD Katie McPeak, MD Mabel Chan, MD Jennie Trinh

Aim Statement ACCESS IMPROVEMENT: – Ultimate goal of increasing patient visits – Route to improvement is through streamlining/shortening the patient visit AIM STATEMENT: “ For primary care patients, decrease total patient time at clinic visits (including registration, clinician time, immunizations, and labs) to <90 minutes per patient by January 1, 2012.”

Changes tested or implemented this Quarter PDSA summary and learning points – Huddles  need more clinician buy in and MEA supervision/training  leadership change/clearer messaging – MEA checklist  not completed by MEAs/not valued by clinicians despite group consensus on implementation  more training and supervision for MEAS, clearer expectations for clinicians and MEAs – Staff satisfaction survey  staff generally happy but different sense of purpose than clinicians  work on teambuilding  repeat survey in June 2011 – QI training  team workshop  QI projects for MEAs, refined clinic-wide QI plan (SFHP PIP in summer 2011) REAL TIME CHANGES ON A DAILY BASIS IN THE CHC!

Data MEAs enter PCP at registration

Challenges Morale and buy-in – Role clarification Lack of leadership skills within primary care nursing team – Lack of larger vision “It’s just more work for us.” “That’s not my job.” – Resistance to change “That’s not my job.” Data – Measures difficult to determine – Collection Where is it? How do we do it? – Analysis Time

Action Plan Sustainable data collection – Measuring cycle time for all primary care – No show rates – Monitoring performance of MEA team in patient assessments – i2i and IT services for ongoing measurement Improve morale and buy-in – Customer service training – Create photo board for all staff – Incentives for improved performance – Examples of successful implementation (visits to other model clinics) – Repeat satisfaction survey Longer term “access”-related goals – Revise provider appointment templates – Revise immunization forms – Decrease no-show rates