1. Analysis of the VUMC Oral Surgery Clinic: Analysis of the VUMC Oral Surgery Clinic: A Systematic Approach to Determining Clinic Access & Efficiency and Space Requirements Shiv Tumkur & Purnima Patel Advisor: Dr. Doris Quinn April 6, 2001 BME 273

2. Motivation VUMC is expanding, and its clinics are finding the need to accommodate increasing demand requirements Future of Clinical Practice in The Vanderbilt Clinic in 2003  E3 – Patient View – Clinician View – Support System View

3. TVC Clinic Redesign Interpersonal Procedures Roles Structure Goals/Mission

4. Establishing the E3 Vision Pilot program with the Oral Surgery Clinic A complete analysis that: – Defines the work of practice – Develops a team to matches that work – Determines optimal resource use

5. The Oral Surgery Clinic Focus – Diagnosis/treatment of jaw and facial deformities as well as oral cavity pathology Clinic leader: Dr. Scott Boyd Informal Leadership: Drs. McKenna and Werther Located on 1st floor of TVC at VUMC

6. Path to Clinical Improvement Clinical Improvement Demand AnalysisCapacity Analysis Process AnalysisSpace Analysis

7. Demand Analysis Demand is a patient’s need for clinical services Identify physical location Identify the current human resources available Future growth potential Summation of internal and external demand  ‘true demand’

8. Capacity Analysis Capacity is the ability to meet the needs of patients seen in clinic True measure of delay: 3 rd available appt. Input Capacity: Number of patients served – Continuity and Access – Measurement of productivity (templated hours vs. actual hours)

9. Process Analysis Developing a team to match the work of the practice – Flowchart of clinical work – Clinical staff activity sheets – Staff questionnaires and interviews – Patient time study – Front desk phone log

10. Space Analysis Identify the number and type of rooms Identify specialized equipment necessary for practice Determine clinic utilization rate (Avg. # of pts. seen / day) x (Avg. exam time per pt) Utilization rate = ------------------------------------------------------------------------------- x 100 ( # of exam rooms ) x ( tot. time clinic sees pts [hrs/day] )

11. Revisiting Clinical Redesign Interpersonal Procedures Roles Structure Goals/Mission

12. Interpersonal Strengths – Opportunity to use initiative and keep pace with job – Satisfaction of working at clinic Weaknesses – Cooperation, communication, attitude, and morale rated fair to poor by 60% of the respondents – High turnover rate of front desk staff

13. Staff Satisfaction Survey N = 5

14. Procedures Variation in appointment scheduling – Booking outside EPIC – Inappropriate booking – Irregularity in scheduling – Confusion in assigning patients to resident or attending Phone traffic Nonfunctional front desk support system Exam and procedure rooms not fully utilized Minimal overall patient wait time

15. Space Assessment

16. Total of 29 patients Data needs to be correlated with the reason for visit/ type of procedure

17. Roles Need to clarify and match staff roles for appropriate scheduling Unclear reporting roles Exclusion of appropriate people when decisions are made Significant backlog  insufficient capacity Current secretarial staff is sufficient to support an additional physician

18. Demand vs. Availability

19. Structure Clinic information systems ineffective for clinic support Some changes are possible currently while waiting for new systems to be rolled out

20. Goals/Mission Data suggests Oral Surgery Clinic has excellent staff willing to provide excellent care for their patients with or without a good support system

21. Recommendations Hire an additional doctor Establish standard front desk procedure Automatic phone routing system Eliminate personal calendar appointments Set-up procedure days Use procedure rooms for procedure only Clarify staff roles

22. Acknowledgements Dr. Paul King Dr. Doris Quinn Center for Clinical Improvement Oral Surgery Clinical Staff Umang Dosi