1. 4C’s Clinic Redesign Operational Snapshot July 28, 2005

2. 4C’s Clinic Redesign Goals: Improved patient satisfaction Reduced length of visit (Cycle Time) Increased Productivity Better Teamwork Improved employee satisfaction Improved patient flow

3. 4C’s Clinic Redesign Strategies: Patient Care Teams Streamlined movement through clinic Aggressive management of resources Preparation before the day of the visit Flexibility and Cross-training

4. 4C’s Clinic Redesign The Model Specific Roles and Responsibilities Registration/Cashier Medical Records Medical Aides Nurses Providers Other Staff

5. 4C’s Clinic Redesign Patient Care Teams Consist of: Provider MA Float MA’s Float Nurse Controller (1 per site) Lab Staff(1 per 2 teams) Support Staff as needed

6. 4C’s Clinic Redesign Streamlined Movement Through Clinic All patients greeted in entry area Eligibility quickly verified Eligible patients with appointments expedited Ineligible (non-current, in need of update) patients routed to Registration Number of ineligible patients in care areas minimized Identified need to reconfigure facilities to improve patient flow.

7. 4C’s Clinic Redesign Aggressive Management of Resources Use of a Controller to monitor status of patient care in real time. Movement of Walk-in patients into DNKA slots as quickly as they are identified. Flexible use of available staff as needed. Cross training in tasks to expedite patient visit.

8. 4C’s Clinic Redesign Preparation before the day of the visit 3 days before visit schedules are run and charts pulled by Medical Records. Registration staff reviews eligibility of patients and contacts patients to advise them of what is needed to renew eligibility and answer any business related questions they may have.

9. 4C’s Clinic Redesign Preparation before the day of the visit (Cont’d) 2 days before visit Float Nurses and MA’s retrieve charts from Medical Records, review charts for completeness Appointment Staff contact the patient to remind them of their visit and to assess reason for visit.

10. 4C’s Clinic Redesign The Day of the Visit The Patient Care Team huddles to discuss the patients of the day and to address issues before the occur. Greeter Greets patients, checks eligibility, (currently eligible patients are sent to the waiting area,others are routed into registration for eligibility verification.)

11. 4C’s Clinic Redesign Controller (Charge Nurse) Assesses patient flow. Coordinates with Triage and Providers to accommodate walk-in patients. Troubleshoots and remove barriers to care Assures that pre-work for future dates is completed in a timely manner. Collects daily data Directs staff as needed to do the job.

12. 4C’s Clinic Redesign Triage Nurse Assesses patients with confirmed eligibility according to 4C’s Triage Guidelines. Coordinates with Controller to accommodate walk-in patients in available slots.

13. 4C’s Clinic Redesign Medical Aide Prepares rooms, welcomes patient, assists provider with visit. Delivers information as directed by provider. Gives patient a satisfaction survey. Makes follow up appointments as needed. Completes all entries on Session Sheet including start and end times. Cleans rooms Participates in cross training for enhanced skills.

14. 4C’s Clinic Redesign Float Nurse Performs nursing services, assesses and Triages according to guidelines, performs nursing visits, performs tasks for Medical Aide as needed.

15. 4C’s Clinic Redesign Provider Participates in huddle, reviews charts to pre-order tests, works with Patient Care Team and Controller, allows Controller to direct patient flow, including walk-ins, provides medical care. Directly communicates with patient regarding complex treatment plans and requests that cannot be accommodated. Recommends appropriate follow-up, documents visit, assists Patient Advocate and staff in resolving patient complaints and issues.

16. 4C’s Clinic Redesign Lab Staff Prepares equipment for phlebotomy in exam room, provides X-ray services, draws blood, processes specimens in lab, returns results to provider when available.

17. 4C’s Clinic Redesign Greeter/Cashier/Registration Charges patients for prescriptions. Thanks patient for coming. Directs patients as needed or to the exit.

18. 4C’s Clinic Redesign Patient Advocate Meets with patients who have a concern or complaint, documents complaints, investigates and works to resolve at the lowest level, follows up with patients about resolution of complaint, compiles periodic report of complaints. Referral Clerk Makes timely referrals, enter them intotracking system, follows up on status of referrals after the prescribed period.

19. 4C’s Clinic Redesign Status Full scale test on July 19 th. Issues identified and addressed. Full scale three day test July 26, 27,28 th completing today Work progressing to address issues identified in test.

20. 4C’s Clinic Redesign Anecdotal Information

21. 4C’s Clinic Redesign Questions?