Practice Management Workshop - PowerPoint PPT Presentation

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Practice Management Workshop

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To get into the office within a reasonable time when they have exacerbations ... Measure flow times through the office visit. Match scheduled time with cycle time ... – PowerPoint PPT presentation

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Title: Practice Management Workshop


1
Practice Management Workshop
  • July 9-11, 2004
  • The Westin OHare Rosemont, IL

2
Office Flow and Patient Satisfaction
  • Andrew Green, MD, FAAAAI
  • Kathleen Conboy-Ellis, ARNP, PhD, FAAAAI
  • Clifford H. Meyer, MBA, CMPE

3
Patient Satisfaction- What Do They Want/Need
  • Patients are our Customers and their Needs
  • Should Drive our Practice

4
Patient Satisfaction - What Do They Want/Need
continued.
  • To get into the practice in a timely fashion when
    they are new patients
  • To get into the office within a reasonable time
    when they have exacerbations

5
Patient Satisfaction - What Do They Want/Need
continued.
  • To be called by name
  • To be treated with respect
  • To be greeted warmly by front office staff- to
    feel welcome

6
Patient Satisfaction - What Do They Want/Need
continued.
  • To have their registration information taken in
    advance
  • Not to have long waits just sitting in waiting
    room
  • To go back and talk with nursing staff before
    seeing physician to be assessed for severity of
    disease (questionnaire, spirometry etc.)

7
Patient Satisfaction - What Do They Want/Need
continued.
  • To have a partnership with the physician and
    health care providers (HCP)
  • To have uninterrupted time with physician/HCP
    focusing on their concerns
  • To be educated on how to use medications,
    inhalers, devices, peak flows

8
Patient Satisfaction - What Do They Want/Need
continued.
  • To have all questions addressed
  • To leave with a written action plan

9
Patient Satisfaction - What Do They Want/Need
continued.
  • To have phone numbers to call in an emergency
    situation
  • To know refill times/call in times
  • To have access to talk to or email a nurse or
    physician between visits

10
Patient Satisfaction - What Do They Want/Need
continued.
  • To have the opportunity attend classes-
    individual or group sessions to cope with their
    chronic illness
  • To be given written teaching sheets on various
    aspects of disease management such as How to use
    your MDI

11
Patient Satisfaction - What Do They Want/Need
continued.
  • Want exit interview /appointment or instructions
    on follow- up
  • To be asked when they leave if their needs have
    been met

12
Patient Satisfaction - What Do They Want/Need
continued.
  • Patients needs can be met better in an office
    thats efficient, organized and flows well.

13
OFFICE FLOW PATIENT SATISFACTION
  • THE DOCTORS PERSPECTIVE

14
Institute For Healthcare ImprovementIdealized
Design of Clinical Office Practices (IDCOP)
15
IDCOP Seeks To Improve
  • Access
  • Clinical outcomes
  • Patient satisfaction
  • Operational efficiency
  • Provider-Staff satisfaction
  • Financial performance

16
Principles of IDCOP
  • Care is based on a continuous healing
    relationship
  • Customized care is based upon patient needs and
    values
  • The patient is the source of control
  • Shared knowledge and free flow of information
  • Care based on best practices delivered
    consistently

17
Principles of IDCOP continued.
  • Reduce risk through care delivery systems
  • Patients should receive information to make
    informed health care choices
  • Anticipate patient needs
  • Avoid wasting resources or time
  • Timely exchange of information and coordination
    of care among providers

18
IDCOP Themes
  • ACCESS the patients ability to get into the
    system
  • INTERACTION what happens when the patient is in
    the system
  • RELIABILITY the patient getting the care they
    need
  • VITALITY the can do spirit and continuous
    focus on how to improve patient care

19
Access
  • Measure backlog by 3rd available appt.
  • Bring capacity in line with demand
  • Increase Capacity
  • expand hours
  • add staff
  • adjust schedules
  • Reduce Demand
  • extend follow-up interval or discharge patient
  • do more at one visit
  • use nurse staff to provide some services
  • create non-visit interaction (e-care)

20
Access continued.
  • Measure flow times through the office visit
  • Match scheduled time with cycle time
  • Reduce wasted time
  • paperwork bottlenecks
  • duplication of work
  • too many hand-offs
  • Improve value-time
  • evaluation
  • treatment
  • education

21
Interaction
  • Measure patient satisfaction of
  • explanations of care
  • visit quality
  • would they recommend the office to others
  • patient delight
  • Indicators of problems
  • patient non-compliance
  • no-shows or transfers out
  • lack of understanding of treatment
  • complaints of too little time given

22
Interaction continued.
  • Indicators of good interaction are
  • Clinical issues are understood and accepted
  • Clinical management is evidence based
  • Patients and doctors set goals and solve problems
  • Care plans are shared and there is appropriate
    follow up

23
Interaction continued.
  • Features of good interaction
  • Customized communication
  • Alternative ways to communicate available
  • informational materials online
  • telephone information
  • teams in the office to meet needs
  • email
  • scheduled interaction online or phone

24
Reliability
  • Definition Exactly the help I need and all and
    only the care I need
  • Problems
  • Failure to use best-practice guidelines
  • Failure to monitor compliance and outcomes
  • Failure to identify ineffective treatment
  • Variability of treatment within the practice

25
Reliability continued.
  • Asthma as an example
  • Are asthma care guidelines followed?
  • indicators of severity documented in record?
  • Objective pulmonary measurements done?
  • Medication use documented?
  • Action Plans issued?
  • Are patients monitored?
  • Periodic review of immunotherapy patients?
  • Is there communication with primary doctors?

26
Vitality
  • Definition an office culture that continuously
    innovates and improves care to patients and
    always sees things through the eyes of the
    patient
  • How measured satisfaction of staff with their
    jobs and feel dedicated to their profession and
    the practice and are enthusiastic about
    continuously improving care to patients

27
Vitality continued.
  • States goals/objectives measures progress
  • Strong, visible leadership and structure
  • Promotes work in teams, communicates among each
    other and gives feedback
  • Empowers staff and delegates tasks
  • Measures staff satisfaction of
  • morale
  • empowerment
  • stress
  • would recommend office to family

28
Satisfied Doctors
  • Were going in the right direction now.
  • My job is more complete.
  • I am practicing better medicine.
  • I bring higher value care to my patients.
  • I am more relaxed.

29
How Important is the Appointment Schedule?
  • When it isnt working!
  • Chaos loss of control
  • Poor patient service satisfaction
  • Lower physician/staff productivity
  • Higher frustration
  • Decline in practice profits

30
Recognizing Signs of Trouble
  • Running behind schedule
  • Patients arriving late
  • Physicians arriving late
  • Cancellations no shows
  • Patient staff complaints
  • Inconsistent charge patterns

31
Examining Scheduling Issues
  • Over booking
  • Under booking
  • No shows
  • Late cancellations
  • Unrealistic scheduling
  • parameters
  • The 15 minute appointment
  • Lack of flexibility

32
Document Current Scheduling Patterns
  • Create appointment scheduling diary for ten
    consecutive days
  • Involve
  • Front office staff
  • Clinical staff staff
  • Document
  • Activities / problems

33
Analyze the Current Schedule Results
  • Appointment scheduling diary
  • Review activities problems that emerged
  • Identify and assess
  • Internal reasons for delays
  • External reasons for delays
  • What is controllable what is not

34
The Virtual Patient -- Phone Calls
  • Track volume
  • Analyze reason for calls
  • Is it necessary?
  • Was patient in recently?
  • Could this have been resolved then?
  • Is this a repeat call
  • Resolve the first time
  • Look for ways to reduce calls

35
Examining Current Scheduling Productivity
  • Conduct time and motions study
  • Track time spent with each patient encounter
    (three day period)
  • Involve all providers
  • Objectives
  • Improve efficiency and time management
  • Improve profitability
  • Improve patient satisfaction

36
The Time and Motion Tracking Tool
  • Create routing form (5x8) that includes
  • Scheduled appointment time time allotted
  • Patient name, age payer type
  • Tracking time
  • Arrival, patient roomed
  • Physician enter / exit room
  • Patient check-out
  • Comment area This is critical

37
Analyze the Time and Motion Study
  • Delays in patient activity
  • Physician actual time with patients
  • Physician transition time
  • Time needed
  • Time wasted
  • Clinical factors

38
Time and Motion Analysis
  • Physician lost time
  • Lack of delegation
  • Inhibitors
  • Valid (uncontrollable)
  • Invalid (controllable)

39
Taking Action
  • Creating realistic scheduling templates
  • Expect the unexpected
  • Implement with accountability
  • Physician and staff
  • Establish daily productivity goals

40
Monitor Results
  • Measure performance against goals
  • Objective findings
  • Conduct follow up studies in 3-4 months
  • The real data
  • tells the real story

41
Taking Your Success to the Next Level
  • Patient satisfaction
  • Set (measurable) goals for wait time
  • Set (measurable) goals for access time
  • The added benefit
  • Increased productivity
  • and higher profits

42
The Competitive Advantage
  • Meeting satisfying patient needs
  • Establish mechanism to measure
  • Conduct patient satisfaction studies
  • Respond to the results by raising the bar
  • Always seek to improve service
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