Microsystems Approach to Improving the Drop-In Clinic

Our Service Provide accessible, equitable and targeted Contraception and Sexual Health services for the residents of Sheffield Open access from 8.30am pm Youth Clinic 3.30 – 6.00pm Appointment clinics running alongside In city centre – ease of access Popular service – 100+ patients per day

In the beginning… Staff stressed, working overtime Pressure on Reception Waiting room full to bursting Waiting time anything from 10m to 2hrs Unable to tell patients how long they would be waiting. Capacity uncontrolled – closing early when too many on list so patients being turned away

Team Approach Started in April 2013 Multidisciplinary Team – invitation to all staff to express an interest Began with Ground Rules and the 5 Ps Lots of number crunching and measuring what we already thought we knew

Mildred Mildred is 21 years old She lives in S5 She is in a new relationship Mildred has attended Drop In clinic for contraception advice What does Mildred want from us? What does Mildred need?

Our Aims TO IMPROVE THE DROP-IN CLINIC WITHIN SCaSH THE PROCESS BEGINS WITH: Patient arrives at clinic THE PROCESS ENDS WITH: When the care is complete BY WORKING ON THE PROCESS WE EXPECT: Reduced waiting times Staff finish on time Not turning patients away To give each patient the time they need IT IS IMPORTANT TO WORK ON THIS NOW BECAUSE: We need to improve the service to meet the changing demand of our patients

Idea: Allocate Patients a Time Slot How long should the slot be? What happens if you run over? What happens if you run out of slots? What about emergency contraception? How do you get a second opinion?

Patient Survey We are considering ways in which we can change the Drop-In Clinic for the better and would be grateful for your opinion on the following. Would you prefer:  an appointment on the same day, or  to wait in a Drop-In clinic.

First Trial One morning only – capacity control using slots 30-minute appointments Patients could choose to go away and come back at their appointment time or sit and wait

It didn’t work! Didn’t have enough appointment slots Patients were asked to come back to pm DI, which increased demand and staff stress levels Some slots weren’t long enough Some were too long Reception staff constantly asking what to do with different patient requests

Perseverance 20 minute slots Some appointments were double-length Blocked one slot at the end for emergencies Separate list for Implants Introduced a “supporting clinician” role Slowly increased duration of the trial until the system was adopted and we were “tweaking”

The Experience “Sometimes Frustrating” Trying to get a consensus Pace of change very slow – need patience and trust in the system “Sense of having achieved something” “Very happy when things work, very anxious when it doesn’t” Team members’ responsibility on clinic floor – “YOUR Microsystem” – need to stay true to the cause. “Take the rough with the smooth”

Experience “The meeting is a safe place to air your frustrations and negativity. There’s always someone to make you feel better.” Excellent to reflect on how far we’ve come and what it was like before. Doctor: “I’ve been off for 6 weeks and can’t believe what a great difference it’s made” “Where are all the patients?” “Makes you feel proud”

Success!! Final Model: Rebranded “Walk In Appointment Clinic” Supporting Clinician role clarified Positive Feedback from staff and patients Worst week = 45 turned away; Last week = none! Staff finish on time Much calmer Feeling of being in control of your working day and pace of working

Challenges Ahead From Jan 2014 Integrated Sexual Health service: SCaSH and GUM Managing patients across 2 sites Working with different skill sets across 2 specialities Offering holistic sexual health service