Access and Redesign

1
Access and Redesign
Providers
Staff
Administration
Patients

• El Centro del Barrio

2
GOAL

• To decrease wait time related to patient access
  and patient flow through the clinic.
• (Decrease wait AT an appointment and FOR an
  appointment.)

3
ACCESS REDESIGN STEPS

• Set Goals and Define Measures
• Staff Buy-in
• Data Collection / Analysis
• Implement Process Improvement for Office
  Efficiency
• Measure / Evaluate
• Implement Process Improvement for Access
• Measure / Evaluate

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SPECIFIC AIMS

• ACCESS
• CentroMed will offer 100 of OB/GYN patients who
  present to the South Park Medical OB/GYN
  Department, a same day appointment with their
  primary care provider by December 2004.
• EFFICIENCY
• CentroMed will decrease the cycle time for
  established patients seen at our South Park
  Medical OB/GYN Department by 30 by December
  2004.

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FIRST STEPS

• Baseline Data Collection
• Demand (Daily) (Appointments requested,
  scheduled, walk-ins, deflections, follow-up)
• Supply (Daily) (No. appointment slots per
  provider)
• Cycle Time (Weekly) (Total time from patient
  check-in to check-out)
• Wait Time To Be Seen By Provider (Weekly) (From
  cycle time)
• Provider No-show Rate (Daily) (From appointment
  logs / sign-in sheets)
• Backlog (Weekly) (3rd next available appt.)
• Panel Size (Monthly) (No. of unique or individual
  patients per provider 18 months)

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BASELINE OB/GYN CYCLE TIME
Total 66 minutes
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OFFICE EFFICIENCY

• SYNCHRONIZE PATIENT, PROVIDER, INFORMATION
• Coordination with M.R. Dept. to pull OB/GYN
  charts 2 days in advance.
• OB/GYN Clerks to review the days ledger and
  ensure chart is present.
• OPTIMIZE ROOMS, EQUIPMENT, STAFF MANAGE
  CONSTRAINTS
• Transfer appointment scheduling from OB Clerks to
  Central Appointment Line staff.
• Transfer next day appointment verification to
  Central Appointment Line staff.
• Reduce interruptions for OB/GYN clerks to prepare
  for incoming patients.
• BALANCE CAPACITY AND DEMAND (non-appt work)
• Maintain appropriate Staff levels.
• Hired additional clerk to staff Central
  Appointment Line.
• Extended Central Appointment Line hours from 500
  pm to 800 pm.

8
ACCESS IMPROVEMENT

• BALANCE DEMAND AND SUPPLY
• Created data collection forms and in-serviced
  clerks.
• Established patient panels for each provider.
• Analyze data and report back to providers and
  staff weekly.
• INCREASE SUPPLY
• Reduce number of appointment types.
• Accommodate walk-ins.
• Accommodate same day telephone appointment
  request.
• REDUCE DEMAND FOR VISITS
• Set up a direct line to the Nurses to handle
  Telephone Triage.
• DEVELOP CONTINGENCY PLANS
• Plan for provider absences before and after
  scheduled absences.

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UNIQUE CHALLENGES TO OB/GYN SPECIALTY

• Separate demand streams for OB and off-site
  surgery.
• Schedule disruptions caused by deliveries /
  surgery delays during clinic hours.
• Patient panel includes mixed population of OB,
  surgery, and well woman physicals.
• High volume of triage calls from pregnant moms
  for same day appointments.

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BASELINE DEMAND AND SUPPLY ACTUAL PER DAY
Supply Provider Slots Per Day Demand Appt
Request, Return Appts Given, Deflections
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BASELINE DEMAND AND SUPPLY PER DAY OF THE WEEK
Monday
Tuesday
Wednesday
Thursday
Friday
5/10, 5/17, 5/24, 5/31
5/11, 5/18, 5/25, 6/1
5/12, 5/19, 5/26, 6/2
5/13, 5/20, 5/27
5/7, 5/14, 5/21, 5/28
Supply Provider Slots Per Day Demand Appt
Request, Return Appts Given, Deflections
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THIRD NEXT AVAILABLE APPOINTMENT DEPARTMENT
AVERAGE PER MONTH
DAYS
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NO SHOW RATEOB PROVIDER AVERAGE
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NO SHOW RATEOB DEPARTMENT AVERAGE
PERCENT
15
CYCLE TIMEOB DEPARTMENT AVERAGE PER MONTH
MINUTES
16
WAIT TIME TO BE SEEN BY PROVIDER DEPARTMENT
AVERAGE
MINUTES
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PANEL SIZE (18 mo)
Provider A Target (2000)
Provider C S Target (1600)
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DEMAND AND SUPPLYPanel X Pt visits / yr (demand)
prov appts / day X days / yr (supply)
Provider A Supply (5016)
Providers C S Supply (5720)
PA (30 pts/day X 5 days per wk) less (4 pts for
9 hr admin./HCH time) X 44 wks 5016
OB/GYN (30 pts/day X 5 days/wk) less (20 pts for
5 hrs surgery / admin. time) X 44 wks 5720
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GOAL PROGRESS 6 MONTHS

• ACCESS
• 50 Reduction 3rd. Next Available Appointment
• (Reduced from 6 to 3 days)
• EFFICIENCY
• 33 Reduction Department Cycle Time
• (Reduced from 49 to 33 minutes)
• 40 Reduction Wait Time To Be Seen By Provider
• (Reduced from 25 to 15 minutes)
• 8 Reduction No Show Rate
• (Reduced from 25 to 23 percent)

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CHALLENGES (BARRIERS)

• COMMITMENT TO SCHEDULING
• FLEXIBILITY FOR APPROPRIATE
• BALANCE OF SUPPLY AND DEMAND
• Providers and Staff
• COMMITMENT TO DATA COLLECTION
• On-going
• Manual
• Staff In-service and continual monitoring

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BENEFITS

• BETTER OFFICE EFFICIENCY MANAGEMENT
• IN TUNE WITH CHANGES IN SUPPLY DEMAND
• INCREASED STAFF AWARENESS
• REDUCED BACKLOG
• REDUCED NO-SHOW RATE
• ESTABLISHED PROVIDER PANELS
• GUIDANCE TO PROVIDERS TO ELIMINATE
• UNNECESSARY VISITS (CHURN)

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SPREAD STRATEGY

• Walzem Clinic, opened Sept. 1st, operates under
  Open Access.
• Teams are being developed at two additional
  clinics
• Somerset Family Clinic
• Santa Rosa Clinic

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KEYS TO SUCCESS
Continual COMMUNICATION with Providers and
Staff. Making them part of the decision making
process gives ownership and buy-in.
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BUSINESS IMPLICATIONS

• Market Differentiation
• Open Access Done Right Improves Patient
  Satisfaction
• Patient Recruitment Retention

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FINAL THOUGHT

• Team Building Data Collection is HARD WORK.
• You Must Measure What You Want To Improve