2. The Ashley Clinic

3. Quality Improvement Lecture Dr. John Bachman & Dr. Alan Wenner Team Concepts Systems PDSA Aims Data variation

4. Control Charts http://www.clinicalmicrosystem.org IHI Open School Concepts of change

5. How Can I use these principles to improve the Ashley Clinic? Wait times were the number 1 complaint by patients and recognized by the physicians as a major problem to patient satisfaction Planned to measure Patient Cycle Times http://clinicalmicrosystem.org Measured cycle times for 5 clinic days Patients filled in the times as they cycled through the clinic

6. Total wait time averaged 52 minutes! Average Cycle Time was 78 minutes!

7. Team assembled Medical Assistants Reception Call Center CEO Chief Nursing officer Discussed IHI model for Improvement Data and charts were examined

8. On call day 3 patients seen at hospital with arrival at 9am 30 minute lunch Last patient complete at 18:02 Unit waiting time was the most significant time resource

9. How do we measure the success? Alteration of the schedule template (NRHC hours, lunch) Standardizing un-occupied rooms for utilization of any provider MA’s work together to room patients. Voice Mail Utilizing Britni’s schedule as alternative Communication – Daily “huddle” between Dr. Thomen, Britni, and the clinical staff to coordinate next day schedule – Patients were encouraged to utilize call center for scheduling TEAMWORK/ COMMUNICATION

10. Aim was to decrease Patient Cycle time to <60 minutes by 5/15/13

11. comparison The patient cycle time by department started with area of concern in the unit waiting area. Resolution was to have more than 1 staff rooming the patients. Total # of patients seen for 5 days: 125(flu season) Balancing Measures – Same number of patients, Voice mail complaints Overall, the Unit waiting was reduced on average from nearly 38 minutes to 13 minutes approximately Total # of patients seen for 5 days: 110 (Thomen), Britni- 26

12. What next? PDSA Implementation of Patient entered History Instant Medical History Dr. Alan Wenner guided the change Started 7/13/13 Read “Switch”, by Chip and Dan Heath 2 patients per day for the first 2 to 3 weeks 82% Completed IMH last week

13. Patient Cycle times 2/13 to 11/13

14. Every system is perfectly designed to get the results it gets John Bachman, MD Total Patient wait times have decreased from 52 minutes to 34 minutes and now 25 minutes An average of 11 minutes has been added for patient entered history February had 125 patients for the measured days, May 110 and November 134