Clinic Efficiency: Using a Team -Based Approach Jennifer ... · Building blocks of high performing primary care: Studied 7 high-performing primary care service sites in California.

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

Thank you!

Questions or comments?

[email protected]

www.FPNTC.org