1. Hailey James, MHA student Adam Criswell, MD student
Improving the quality of free care: An interprofessional approach to quality management at a student-run free clinic
Hailey James, MHA student
Adam Criswell, MD student

2. The CARES Clinic Clinic operates Mon., Tues. & Thurs. evenings
6-10 patients/night
Offer psychiatry, gynecology & PT/OT services
Provide free lab and radiology services and free or reduced referrals
Interprofessional board – MD, PT, OT, PA, MHA & Pharmacy students,

3. Why Quality Improvement?
Clinical Education
Patient Care
Patient satisfaction
Patient Safety
Quality care
Student Learning
Interprofessional Opportunity

4. What is quality? Safe Effective Patient-centered Timely Efficient
Equitable
Six dimensions of quality as defined by the Institute of Medicine in the Crossing the Quality Chasm report.

5. How did we decide where to start?
We knew we needed to create a system of quality management
Started with the results of a previous patient satisfaction study done in 2010.
Ellett, JD, Campbell JA, Gonsalves WC. Patient satisfaction in a student-run free medical clinic. Fam Med 2010; 42(1):
Our aim for this quality improvement project formed in response to the results of the CARES patient satisfaction survey published in January 2010 issue of Family Medicine that found wait times had the poorest rating with a 2.92+/ on a 5-point Likert scale.
Our bigger objective was to create a system of quality management.

6. Continuous Quality Improvement
What is our Aim?
To improve patients’ perception of clinic wait times.
And/or to decrease wait times.
How will we know change is an improvement?
Improved scores on Likert scale survey.
Reduction in measured wait times.
What changes can we make that will result in improvement?
Answers to follow

7. Data Collection Quantitative data- patient time card
Qualitative data- patient focus group

8. Patient Time Card Data- process flow
Patient arrives
Patient is let into clinic
Patient is taken back to patient room
Patient leaves
First come, first served- cannot control arrival time
Have to wait for day clinic to close

9. Patient Time Card Data N=30
57% of patient’s time spent in the waiting room is value added. The end of the bar represents two standard deviations from the mean. 95% of patients % value added time was between the range of 29% and 85%.
Value added is defined as time spent with someone in the room (a student and/or doctor).
N=30

10. Patient Time Card Data
We ran a regression and there were NO correlations between either total wait time (in patient room) or percent value-added time with patient satisfaction. However…
No correlations, but very high over all satisfaction. Only 1 patient scored below 3 (or neither satisfied nor dissatisfied).

11. Patient Time Card Data What does this data mean?
Once patients are back in a patient room they are quite satisfied
We need to look for room for improvement outside of the patient room
What does the qualitative data say?
D.A. Thompson and P.R. Yarnold, Relating patient satisfaction to waiting time perceptions and expectations: the disconfirmation paradigm, Academic Emergency Medicine 2 (12) (1995), pp.
K. Katz, B. Larson and R. Larson, Prescription for the waiting in line blues: entertain, enlighten and engage, Sloan Manag Rev (1991), pp. 44–53.
Maister DH. The psychology of waiting lines. Available at: Accessed July 7, 2009.

12. Patient Focus Group- Nominal Group Technique
Generate Ideas
Record Ideas
Discuss Ideas
Vote on Ideas
Immediate participant involvement
Option for anonymous participation
Equal participation
Stimulates conversation

13. Patient Focus Group Feedback
Alert on website on how many doctors are at clinic
Ability to call the doctors
Provide information of other free services in the area
Have clip board outside as a patient sign in
Learn more about diabetes and weight loss
Expand number of clinic days
Open on Saturdays
Free eye care
Get 3 to 6 months worth of a prescription
Provide additional shelter to wait in/under

14. Patient Focus Group Feedback
Alert on website on how many doctors are at clinic
Ability to call the doctors
Provide information of other free services in the area
Have clip board outside as a patient sign in
Learn more about diabetes and weight loss
Expand number of clinic days
Open on Saturdays
Free eye care
Get 3 to 6 months worth of a prescription
Provide additional shelter to wait in/under

15. Changes for Improvement
Create Quality Manager board position
Assigned improvements to the appropriate board position
Website update on number of doctors available
Update CARES pamphlet and print more copies
MHA students pass out clip board when they arrive
Public health interest group start monthly diabetes/weight management clinic
Include free eye clinic information and how to sign up in pamphlet
Looking into using neighbor facility as shelter

16. Looked at what the data tell us
Improvement cycle
Defined our aims
Decided what data is needed
Plan
Collected wait time data
Held patient focus group Do
Looked at what the data tell us
Study
Created MHA position
Assigned suggested changes
Act

17. What we learned
Quality management is a culture and a way to keep a focus on the patient perspective
The structure of the model has allowed us to get an insight into what our patients want.
Both the quantitative and qualitative data have pointed to similar conclusions.
Perception vs. length of wait times
Pawlowski A. Queuing psychology: can waiting in line be fun? CNN website. Available at: Accessed July 7, 2009.

18. Thank you! Questions?