SFGH Children’s Health CenterQuarterly Report, June 2011

CHC Stats• 12,700 patients• 16,000 primary care visits annually• Provider FTE

• NPs: 2.24 FTE• MDs: 1.73 FTE• Residents: 1.89 FTE

• MEA/LVN FTE• 4.0 MEAs + as needed• 4.5 RNs• 3 LVNs (1 currently on leave)• 2 clerks and 1 senior clerk• We have 7.6 FTE and need

8.5-12.75 FTE!

The Children’s Health Fairies• Lannie Adelman, RN, MS, MBA• Shonul Jain, MD• Shannon Thyne, MD• Katie McPeak, MD• Mabel Chan, MD• Jennie Trinh

Aim Statement

• ACCESS IMPROVEMENT:– Ultimate goal of increasing patient visits– Route to improvement is through streamlining/shortening the

patient visit• AIM STATEMENT:“ For primary care patients, decrease total patient time at

clinic visits (including registration, clinician time, immunizations, and labs) to <90 minutes per patient by January 1, 2012.”

Changes tested or implemented this Quarter

• PDSA summary and learning points– Huddles need more clinician buy in and MEA

supervision/training leadership change/clearer messaging

– MEA checklist not completed by MEAs/not valued by clinicians despite group consensus on implementation more training and supervision for MEAS, clearer expectations for clinicians and MEAs

– Staff satisfaction survey staff generally happy but different sense of purpose than clinicians work on teambuilding repeat survey in June 2011

– QI training team workshop QI projects for MEAs, refined clinic-wide QI plan (SFHP PIP in summer 2011)

REAL TIME CHANGES ON A DAILY BASIS IN THE CHC!

Data

020406080

100120

Average time from arrival to departure whole clinic

time

in m

inut

es

Oct-10 Nov-10 Dec-10 Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-113334353637383940414243

Empanelment data for 6M CHC

% of pts unassigned to PCP

MEAs enter PCP at registration

3/1/11-3/15/11

3/15/11-3/31/11

4/1/11-4/15/11

4/16/11-4/30/11

5/1/11-5/15/11

0

20

40

60

80

100

120

Pilot Time Study Tues PM Clinic

arrival time to time in room Total Time

Tim

e in

min

utes

satisfied

with jo

b

nursing w

orks w

ell toge

ther

cleric

al works

well

together

clinica

ns and nursi

ng works

well

feels r

ecogn

ized fo

r serv

ice

treate

d fairly

020406080

6M staff satisfaction survey

% agree or strongly agree

Challenges• Morale and buy-in

– Role clarification• Lack of leadership skills within primary care nursing team

– Lack of larger vision• “It’s just more work for us.”• “That’s not my job.”

– Resistance to change• “That’s not my job.”

• Data– Measures difficult to determine– Collection

• Where is it? How do we do it?– Analysis

• Time

Action Plan• Sustainable data collection

– Measuring cycle time for all primary care– No show rates– Monitoring performance of MEA team in patient assessments– i2i and IT services for ongoing measurement

• Improve morale and buy-in– Customer service training – Create photo board for all staff– Incentives for improved performance– Examples of successful implementation (visits to other model clinics)– Repeat satisfaction survey

• Longer term “access”-related goals– Revise provider appointment templates– Revise immunization forms– Decrease no-show rates