clinic efficiency: using a team -based approach jennifer ... · building blocks of high performing...
TRANSCRIPT
Clinic Efficiency: Using a Team-Based Approach
Jennifer Kawatu, RN MPHFPNTC
Disclosure
• Nothing to disclose
Objectives
By the end of the session, participants will be able to:
• Explain the advantages in using a team-based approach to care.
• Describe a data-driven approach to assessment of staff utilization and productivity.
• List at least 2 strategies for increased utilization of a team-based care.
Quality Care According to the Provider
Safe
Effective
Patient-Centered
Timely
Efficient
Equitable
Clinician Time
Time spent on:• Clerical work +• Documentation +• Pharmacy +• Insurance +_____________________________________________________
• Burnout• Frustration• Underutilization
What are you hearing?
Building blocks of high performing primary care:
Studied 7 high-performing primary care service sites in California. Found in common: 1. Data-driven improvement2. Empanelment 3. Team-based care4. Population management5. Continuity of care6. Prompt Access to care Source: California HealthCare Foundation. The Building Blocks of High Performing Primary Care
LEAP
The Primary Care Team: Learning From Effective Ambulatory Practices (LEAP):Involvement of medical assistants, nurses and other staff in delivering clinical services to the maximum extent:
– substantial improvements in disease control– satisfaction with overall care and with their
provider increase– less job exhaustion and burnouthttp://www.improvingprimarycare.org
Team
What is a team?
A team is a group of people working together to achieve a common purpose for which they hold themselves mutually accountable.
What is teamwork?
Key Principles
• Every patient is assigned to a care team– Clinician, medical assistant, nurse, and front desk– Clinician, medical assistant
• All team members contribute to patient care• Tasks delegated • Team members are working at the top of their
license• The team huddles daily; meets regularly
Team-Based Care May Include: • Proactive planned care• Sharing clinical care among a team• Expanded care• Shared clinical tasks• Collaborative documentation (scribing)• Non-clinician order entry• Streamlined prescription management• Verbal messaging and in-box management• Co-location, team meetings, and work flow mapping,
etc.
Advantages
1. Improved care experience2. Better outcomes3. Lower cost4. Happier staff
Challenges
• Reimbursement• Leadership and culture• Collaboration and trust
What other challenges?
What does it look like?
• More involvement with patients (of non-clinician staff)
• Expanded care roles (counseling, collecting info, putting in labs, etc.
• Working the top of their skill set• Staff devote more time to meet with each
other (huddle, quality of care meetings, etc.)• Make every member feel they are having an
input and an impact
Getting Started
1. Define Goals and develop a shared aim.2. Assign and train for roles, delegate functions3. Systems adjustments4. Put in systems for sustainability
Define Goals
• Define goals and develop a shared aim• Create a sense that these are our patients• Define specific measureable outcomes and
objectives
Demand and Capacity
Demand – patient requests for care
– Influenced by appointment systems, reputation, outreach, patient experience, etc.
Demand and Capacity
Demand – patient requests for care
– Influenced by appointment systems, reputation, outreach, patient experience, etc.
Capacity – ability to meet those requests
Demand and Capacity
Demand – patient requests for care
– Influenced by appointment systems, reputation, outreach, patient experience, etc.
Capacity – ability to meet those requests
– Influenced by appointment systems, staff utilization and productivity, clinic flow
Demand and Capacity
Identify your capacity and match it to your demand
- Too much capacity, not enough demand?- Too much demand, not enough capacity?
DEMAND CAPACITY
Demand and Capacity
Identify your capacity and match it to your demand
– Match resources/staff with predictable variations in demand
– Assess capacity through data – not through appointment system
DEMAND CAPACITY
Staff Utilization and Productivity Data
Staff Utilization and Productivity• Assign roles and define
functions and tasks– Create broad work roles
and cross-train staff– Ensure each team
member is prepared– Have all staff work to the
top of their license– Ensure clinic systems
support defined work
Staff Utilization and ProductivityIncrease clinician support
– Shadow staff– Improve communication
between clinicians and other staff
– Encourage teamwork– Optimize EHR for
efficiency
Staff Utilization and Productivity Productivity standards and goals… one size does not fit all
– National Family Practice: 2.74/hour average– 2-3?– 3-4?– 4-6?
Common goal: 3-4 per hour
http://bphc.hrsa.gov/uds/datacenter.aspx?q=tall&year=2013&statehttp://www.washingtonpost.com/news/to-your-health/wp/2014/05/22/how-many-patients-should-your-doctor-see-each-day/
Adjust Systems
• Ensure clinical and administrative systems support team members in their defined work
• Create communication structures and processes
Systems for Sustainability• Use data to assess team progress and
performance at least every month, ideally every week
• Practice teamwork• Be innovative and try new things• Share your learning with other care teams at
your site and at other health centers
Clinic Efficiency DashboardClinic Efficiency Dashboard: www.clinicefficiency.com
Clinic Efficiency Dashboard
Clinic Efficiency Dashboard: www.clinicefficiency.com
Resource Links
Family Planning Clinic Efficiency Dashboard (website)www.clinicefficiency.com
Using Data to Increase Clinic Efficiency: A Quality Improvement Guide (toolkit)https://www.fpntc.org/training-and-resources/using-data-to-increase-clinic-efficiency-a-quality-improvement-guide
