1. Patient-Flow Analysis for Windows (WinPFA) [Georges Seurat Etude pour 'Une dimanche à I'lle de la Grande Jatte' (1884)]

2. Today’s Menu Service delivery issues in STD clinics Questions relating to those issues & WinPFA WinPFA and its basic premises Data collection fundamentals Technical support resources Workshopping WinPFA

3. Possible Service Delivery Issues in STD Clinics Clinic flow Appointment system Staff utilization Physical plant management Emergency management Access Costs

4. Related Questions & WinPFA Issue & QuestionsWinPFA? Clinic flow How does client waiting time vary?routine What is the mean waiting time between securing an appointment and receiving services? difficult Appointment system Are walk-ins seen quicker than appointed clients? easy not routine Are appointment “slots” too short, too long? moderately difficult

5. Related Questions & WinPFA Issue & QuestionsWinPFA? Staff Utilization Are staff overburdened by paperwork?difficult How much staff time is devoted to translation for other staff? routine Physical Plant Management Are waiting room accommodations adequate? difficult Are restrooms and exam rooms cleaned on a periodic basis? routine

6. WinPFA’s Critical Characteristics Systems’ analysis Quantify clinic flow “Prescribed” methodology No-$$ CDC software Evaluate existing clinics & plan new clinics

7. WinPFA’s Premises: Clinic problems: either the systems or people Change is quantifiable Staff know the system Incremental change works best

8. The Signature PFA Graph

10. Planning and Executing a WinPFA Data Collection Identify your issues Identify all flows Draft, test, & re-test your data collection design Orient staff and implement D-C Enter data & generate reports (Half dozen other implementation steps)

11. Your Expenditures Software Hardware Staff training Learning curve Data analysis and application

12. Waiting Time

13. First Word “The Cleveland Clinic research… points to four systems factors that stand out in importance for the patient’s point of view: Efficient provision of service; Ability to get appointments quickly; Time spent waiting for the doctor; Time spent waiting for tests.” [Leebov, Patient Satisfaction: A Guide to Practice Enhancement (1990, Medical Economics Company, p.23]

14. Waiting Time and Client Satisfaction

15. Final Word?

17. Data to Action Space utilization Regularized client-flow allows reduced size waiting area FTE level Phlebotomist’s burden results in un-freezing positions WIC nutritionist + translator burden justifies hiring spanish-speaking nutritionist Appointment system re-enforced Early arriving appointed clients prioritized after on-time clients Cost reduction HIV counseling no longer handled by most medically skilled staff

18. Your Questions?

19. Technical Support Over-the-phone TA: 770/488-6301 Questions and listserv Subscription: WBoyd@cdc.gov or pfa@cdc.gov Down-loads: http://www.cdc.gov/reproductivehe alth/Products&Pubs/PFA_support/I nstructions.htmRequest Our list of experienced contractors

20. Workshopping WinPFA Small groups at each laptop Explore or wait for preceptor Compare questions and reports Schedule follow-up for more TA