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Union County Department of Human Services Division of Public Health January 23, 2014 Everyone wants to improve, but No One Wants to Change.

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Presentation on theme: "Union County Department of Human Services Division of Public Health January 23, 2014 Everyone wants to improve, but No One Wants to Change."— Presentation transcript:

1 Union County Department of Human Services Division of Public Health January 23, 2014 Everyone wants to improve, but No One Wants to Change

2 Multi-disciplinary Team 2

3 Project Aim Statement: Eliminate non-value added clinical visit time from the point of entry through check-out and create accurate, error free encounters from clinic to billing. Union County Charter MeasureBaselineGoal Average amount time patient spends in a clinical visit at the Health Dpt 101.23 minutes68.18 minutes Reduce or eliminate non-value added steps within the clinic visit process 33.05 minutes of non-value added time per visit Reduction of 30% from the overall average clinical time Decrease encounter errors passed from clinical staff to business service staff In Progress Error free encounters leaving clinic in preparation for EMR 3

4 Data Collection Tools QI Cycle Times Gemba Walks PDSAs 4

5 Value Stream Maps (VSM) 5

6 Comparison Data March / April 2013 Maternity High Risk Maternity Child Health Family Planning General - STD Immunizations Over-all Average Average - Provider Clinics Wait time from Check-in to Processing6.90 4.49 4.754.765.75 4.80 5.24 5.23 Wait time at Processing4.06 3.89 6.595.489.92 5.98 5.99 5.01 Wait time from Processing to Fee Window4.92 4.43 4.956.625.85 7.77 5.76 5.23 Wait time at Fee Window3.36 3.61 4.036.916.85 6.72 5.25 4.48 Wait time from Fee Window to Clinic17.14 17.09 25.3314.8118.66 6.42 16.58 18.59 Wait time in Clinic65.42 72.77 55.7666.0140.89 17.47 53.05 64.99 Wait time from Clinic to Check-out6.67 6.06 2.234.840.37 1.14 3.55 4.95 Wait time at Check-out7.74 6.01 2.136.220.52 1.50 4.02 5.53 Total Visit Time (minutes)116.21118.35105.77115.6588.8151.80 99.43 114.00 Visit Time (without waits)80.5886.2868.5184.6258.1831.67 68.31 80.00 Non-value added wait times35.6332.0737.2631.0330.6320.1331.1334.00 Aug-13 Maternity High Risk Maternity Child Health Family Planning General - STD Immunizations Over-all Average Average - Provider Clinics Wait time from Check-in to Processing3.88 3.93 3.515.596.45 2.20 4.26 4.23 Wait time at Processing2.64 2.52 3.963.754.45 4.00 3.55 3.22 Wait time from Processing to Fee Window3.52 3.93 7.716.786.33 5.77 5.49 Wait time at Fee Window3.19 2.81 4.696.598.69 10.04 6.00 4.32 Wait time from Fee Window to Clinic26.27 21.15 16.8820.9711.77 14.12 18.53 21.32 Wait time in Clinic58.18 65.41 65.0768.9130.73 15.68 50.66 64.39 Wait time from Clinic to Check-out8.18 2.88 4.005.500.00 2.83 3.90 5.14 Wait time at Check-out5.98 7.00 4.527.000.00 7.40 5.32 6.13 Total Visit Time (minutes)111.84109.63110.34125.0968.4262.60 97.99 114.23 Visit Time (without waits)69.9977.7478.2486.2543.8737.12 65.54 78.06 Non-value added wait times41.8531.8932.1038.8424.5525.4832.4536.17 Visit Times Decreased Non-Value Added Wait time decreased Total Visit Time Decreased 6

7 Data Capabilities – Providers Provider / # of forms collectedDr. A (21)Dr. B (12)Dr. C (24)Dr. D (44)PE A (5)PE B (14)PE (27) Wait time from Check-in to Processing2.25 0.18 2.73.723 2.69 2.9 Wait time at Processing2.86 4.75 3.463.196.4 3.07 3.96 Wait time from Processing to Fee Window4.95 4 8.16.674.67 7.93 7.46 Wait time at Fee Window2.65 4.38 4.684.257.33 5.43 4.87 Wait time from Fee Window to Clinic20.26 9.5 1116.6323.33 9.36 26.71 Wait time in Clinic73.33 41.00 55.5765.1990.50 47.08 69.33 Wait time from Clinic to Check-out2.83 24.52 8.5 7.17 Wait time at Check-out6.15 4.646.223.00 6.13 5.54 Total Visit Time (minutes)115.2863.8192.15110.39138.2390.19127.94 Visit Time (without waits)84.9950.1368.3578.85107.2361.7183.7 Non-value added wait times30.2913.6823.831.543128.4844.24 7

8 Clinic Wait Time Chart 8

9 Return on Investment - Tangible Clinical Navigator Child Health Walk-in Work-In Kanban Inventory System Business Service Standardization of Work Stations Business Services Cross-training Condensed Encounter Forms 9

10 Return on Investment - Intangible Multi-disciplinary Team Culture Change Positive Peer Pressure Developed Foundation for EHR Implementation 10

11 Return on Investment –Monetary Projections Gain 3 hours of MOA Salary Time per week due to Kanbab = $3,270 annually Gain additional clinical access through more efficient clinic flow 4 Child Health Physicals per week @ $90.00 Medicaid Rate = $18,000 annually 4 Family Planning visits per week @ $142.00 Medicaid Rate = $28,400 annually Total annual reductions = $49,670 11


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