“QI Ladybugs” Decrease Child Health Clinic Visit Time

NAME OF HEALTH DEPARTMENT: Gaston County Health Department

PROJECT TITLE: “QI Ladybugs” Decrease Child Health Clinic Visit Time

PROJECT TEAM LEAD AND CONTACT INFO:
Veronica Costner
704-853-5013
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Project Overview

Project Aim:
In our Child Health Clinic we aim to decrease the patient total visit cycle time by 25% by improving clinic flow from check-in to check-out.  We will accomplish this by June 30th, 2011.  This is important because patients and staff have stated the wait times are too long and by decreasing the wait time we will improve patient and staff satisfaction.  This will benefit both the patients and staff members.  We will achieve this by using QI methods we learn with QI101 and utilizing the Method of Improvement and Lean Methodology.

Goals:

  • Implementing vision charts in all nine exam rooms (increasing vision stations from 1 to 9)
  • Decrease time of prepping patient records by 50%
  • Achieve a patient and staff satisfaction score of 85% or greater.
  • Implement self history form so patients can become more involved in their patient care.
  • Decrease total time for Well visits from 2 hours to 1 ½ hours which will be a 25% decrease.
  • Decrease the amount of paperwork for staff by consolidation of forms and eventually increasing the number of patients seen in clinic by 50%.

Project timeframe:
November 2010 to October 2011 (extended to complete renovations in Child Health Clinic to increase the flow)

How was the need for the project determined?
Gaston County Health Department need for the project was determined by the long wait times and no show rates of our patients and also the staff and patient dissatisfaction.  We based need based on the survey of the patients and staff members.

Does this quality improvement project link to accreditation?
Yes, Accreditation focuses on a set of minimal standards that must be provided to ensure the protection of the health of the public.  A strategic plan is required and GCHD plan included “conduct clinical quality improvement and outcomes.”  GCHD set goals that includes:  to improve clinic flow for patients, increase patient and staff satisfaction, increase patient case- load, increase staff efficiency, and improve community health status.

Areas for Improvement and Changes Ideas Implemented

Improvement 1
Implementing vision charts in all nine exam rooms (increasing vision stations from 1 to 9)

  • Vision Charts were placed in seven exam rooms, one exam is a work room and one exam room is only used for sick visits and do not need vision charts.  It assisted with our efficiency and improved patient satisfaction by becoming “patient centered”

Improvement 2
Used too much time to prep records. Decrease time of prepping patient records by 50%

  • We were able to decrease time of prepping patient records by re-assigning Certified Medical Assistants to prep records and realigned staff tasks.  This process that took almost 8 hours only takes 1 ½ hours total which also increased efficiency and improve staff satisfaction.

Improvement 3
Achieve a patient and staff satisfaction score of 85% or greater.

  • We have completed initial surveys to develop baseline and continue to be in process of evaluating satisfaction after completing remaining improvement processes.

Improvement 4
Implement self history form so patients can become more involved in their patient care.

  • We have implemented self history forms and patients are more involved in their care.  This process has also increased efficiency for our clinic flow and increased staff satisfaction.

Improvement 5
Decrease total time for Well visits from 2 hours to 1 ½ hours which will be a 25% decrease.

  • We have accomplished this goal and have had some visits that only took 49 minutes and we continue to monitor this measurement by using time study slips. 

Improvement 6
Decrease the amount of paperwork for staff by consolidation of forms and eventually increasing the number of patients seen in clinic by 50%.

  • We have not increased the number of clients seen in our clinics due to staffing issues and scheduling but we were able to decrease forms from 18 to 8.

Results

Overall Improvements

  • Established an efficient referral process.
  • Process for record prep is more efficient and staff members are more satisfied.
  • Eliminated duplicated work.
  • Eliminated unnecessary forms which increased efficiency for our clerks.
  • Decreased total cycle time for our patients.
  • Empowered our patients to become more involved with the care of their children.
  • Will restructure clerical area to become more patient friendly and remain in compliance with HIPAA.
  • Reduce clerical FTE’s in half (clerical staff was reduced by attrition).

Lessons Learned:

  • Kaizen Event was time consuming but worth it to take the time out and focus on what needed to done to improve our Child Health Clinic.
  • Spread ability of changes need to be continually shared with other staff and QI Team should have a plan to share with staff.
  • Clueless member of the team brings fresh ideals that can change the most important item because they are not “invested” in current process and are able to “a fresh look”.
  • It takes the entire team to make change, and sustain the change!
  • 5 S is a must and it needs to continue daily.
 

Programs supported by:

BlueCross BlueShield of NC FoundatoinThe Duke Endowment

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