Union County Department of Human Services

Division of Public HealthJanuary 23, 2014

“Everyone wants to improve, but No One Wants to Change”

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Multi-disciplinary Team

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Project Aim Statement:Eliminate non-value added clinical visit time from

the point of entry through check-out and create

accurate, error free encounters from clinic to billing.Union County CharterMeasure Baseline Goal

Average amount time patient spends in a clinical visit at the Health Dpt

101.23 minutes 68.18 minutes

Reduce or eliminate non-value added steps within the clinic visit process

33.05 minutes of non-value

added time per visit

Reduction of 30% from the overall average

clinical time

Decrease encounter errors passed from clinical staff to business service staff

In ProgressError free encounters

leaving clinic in preparation for EMR

     

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Data Collection Tools• QI Cycle Times• Gemba Walks• PDSA’s

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Value Stream Maps (VSM)

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Comparison DataMarch / April 2013 Maternity

High Risk Maternity

Child HealthFamily

PlanningGeneral -

STDImmunization

sOver-all Average

Average - Provider Clinics

Wait time from Check-in to Processing 6.90

4.494.75 4.76 5.75

4.805.24

5.23

Wait time at Processing 4.06 3.89 6.59 5.48 9.92 5.98 5.99 5.01Wait time from Processing to Fee Window 4.92

4.434.95 6.62 5.85

7.775.76

5.23

Wait time at Fee Window 3.36 3.61 4.03 6.91 6.85 6.72 5.25 4.48Wait time from Fee Window to Clinic 17.14 17.09 25.33 14.81 18.66 6.42 16.58 18.59Wait time in Clinic 65.42 72.77 55.76 66.01 40.89 17.47 53.05 64.99Wait time from Clinic to Check-out 6.67 6.06 2.23 4.84 0.37 1.14 3.55 4.95Wait time at Check-out 7.74 6.01 2.13 6.22 0.52 1.50 4.02 5.53             Total Visit Time (minutes) 116.21 118.35 105.77 115.65 88.81 51.80 99.43 114.00Visit Time (without waits) 80.58 86.28 68.51 84.62 58.18 31.67 68.31 80.00Non-value added wait times 35.63 32.07 37.26 31.03 30.63 20.13 31.13 34.00

Aug-13 MaternityHigh Risk Maternity

Child HealthFamily

PlanningGeneral -

STDImmunization

sOver-all Average

Average - Provider Clinics

Wait time from Check-in to Processing 3.88

3.933.51 5.59 6.45

2.204.26

4.23

Wait time at Processing 2.64 2.52 3.96 3.75 4.45 4.00 3.55 3.22Wait time from Processing to Fee Window 3.52

3.937.71 6.78 6.33

6.335.77

5.49

Wait time at Fee Window 3.19 2.81 4.69 6.59 8.69 10.04 6.00 4.32Wait time from Fee Window to Clinic 26.27 21.15 16.88 20.97 11.77 14.12 18.53 21.32Wait time in Clinic 58.18 65.41 65.07 68.91 30.73 15.68 50.66 64.39Wait time from Clinic to Check-out 8.18 2.88 4.00 5.50 0.00 2.83 3.90 5.14Wait time at Check-out 5.98 7.00 4.52 7.00 0.00 7.40 5.32 6.13             Total Visit Time (minutes) 111.84 109.63 110.34 125.09 68.42 62.60 97.99 114.23Visit Time (without waits) 69.99 77.74 78.24 86.25 43.87 37.12 65.54 78.06Non-value added wait times 41.85 31.89 32.10 38.84 24.55 25.48 32.45 36.17

  Visit Times Decreased  Non-Value Added Wait time decreased  Total Visit Time Decreased

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Data Capabilities – Providers

Provider / # of forms collected

Dr. A (21) Dr. B (12) Dr. C (24) Dr. D (44) PE A (5) PE B (14)

PE (27)

Wait time from Check-in to Processing 2.25

0.182.7 3.72 3

2.692.9

Wait time at Processing 2.86 4.75 3.46 3.19 6.4 3.073.96

Wait time from Processing to Fee Window 4.95

48.1 6.67 4.67

7.937.46

Wait time at Fee Window 2.65 4.38 4.68 4.25 7.33 5.434.87

Wait time from Fee Window to Clinic 20.26

9.511 16.63 23.33

9.3626.71

Wait time in Clinic 73.33 41.00 55.57 65.19 90.50 47.0869.33

Wait time from Clinic to Check-out 2.83

 2 4.52  

8.57.17

Wait time at Check-out 6.15   4.64 6.22 3.00 6.135.54

        

 

Total Visit Time (minutes) 115.28 63.81 92.15 110.39 138.23 90.19 127.94

Visit Time (without waits) 84.99 50.13 68.35 78.85 107.23 61.71 83.7

Non-value added wait times 30.29 13.68 23.8 31.54 31 28.48 44.24

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Clinic Wait Time Chart

Wait

time fro

m Check-in

to Pro

c...

Wait

time at P

roces

sing

Wait

time fro

m Proces

sing t

o Fe...

Wait

time at F

ee W

indow

Wait

time fro

m Fee W

indow to C...

Wait

time in Clin

ic

Wait

time fro

m Clinic t

o Check...

Wait

time at C

heck-out

0.00

10.00

20.00

30.00

40.00

50.00

60.00

70.00

80.00

5.24 5.99 5.76 5.25

18.50

52.93

3.55 4.02

QI Clinic Wait Times

Over-all Average Maternity High Risk Maternity Child Health Family Planning General - STD

Immunizations Wait

Min

utes

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Return on Investment - Tangible

• Clinical Navigator• Child Health Walk-in Work-In• Kanban Inventory System• Business Service

Standardization of Work Stations

• Business Services Cross-training• Condensed Encounter Forms

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Return on Investment - Intangible

• Multi-disciplinary Team• Culture Change• Positive Peer Pressure• Developed Foundation for

EHR Implementation

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Return on Investment –Monetary Projections

• Gain 3 hours of MOA Salary Time per week due to Kanbab = $3,270 annually

• Gain additional clinical access through more efficient clinic flow

• 4 Child Health Physicals per week @ $90.00 Medicaid Rate = $18,000 annually

• 4 Family Planning visits per week @ $142.00 Medicaid Rate = $28,400 annually

• Total annual reductions = $49,670