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

2. 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

3. 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

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

5. Rationale for Focusing on Clinic Efficiency

6. 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 Realizing transformational change through improvement in public health. Journal Public Health Management Practice; 16 (1):72-78.

7. 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

8. 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

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

10. Workflow and Staffing Strategies

11. 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 Clinic Efficiency: A Compendium of Strategies and Recommendations for Title X Family Planning Programs. Washington, DC: Government Printing Office.

12. 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

13. 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 Clinic Efficiency: A Compendium of Strategies and Recommendations for Title X Family Planning Programs. Washington, DC: Government Printing Office.

14. 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!

15. 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) Office Visit Cycle Time: Improving Primary Care Access; HIMSS Financial Systems Revenue Cycle Management: A Life Cycle Approach for Performance Measurement and System Justification.

16. 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) Patient Wait Times, Optimal Panel Sizes, and Handling No Shows.

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

18. 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)

19. 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?

20. 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 How many staff members do you need? Family Practice Management; 9(8):45-49.

21. 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 Panel size: how many patients can one doctor manage? Family Practice Management; 44–51.

22. 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 Lessons for Financial Success: Productivity, Capacity and Staffing.

23. 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 Lessons for Financial Success: Productivity, Capacity and Staffing.

24. 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!

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

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

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