1. Process Improvement at the Phillips Neighborhood Clinic Dan Hottinger: Process Improvement Chair Rob Fraser: Co-chair

2. The PNC Location: South Minneapolis Served 1100 patients in ‘09-’10 –14 patients/night, 2 nights/week Students: 300+ total –Medicine, Public Health, Nutrition, Social Work, Pharmacy, Physical Therapy, Nursing

3. Objectives Understand the WHAT, WHO, and HOW of process improvement Learn how to apply process improvement strategies to your own clinic

4. What is PI? Process improvement is… –Identifying a problem –Analyzing the problem –Improving the associated process –Evaluating the changes Always adapted to circumstances

5. Who does PI? 1.Clinic leadership 2.Process Improvement committees 3.All clinic team members

6. PI at the PNC

7. PI at the Phillips Neighborhood Clinic Our formal process for making changes 1.Identify problem source with root cause analysis 2.Brainstorm possible solutions with stakeholders 3.Propose solution to leadership 4.Approve +/- modifications 5.Enact +/- piloting 6.Evaluate 7.Formalize change (Policy Manual, etc.)

8. PNC PI Examples 1.Volunteer training 2.Education service expansion 3.Pharmaceuticals and Therapeutics Committee 4.Second year public health role 5.Strategic Planning Committee

9. Ex. 1: Human Resource Improvements Identify problem –Inadequate volunteer training Volunteers unfamiliar with clinic flow Volunteer dissatisfaction with preparedness –Negative effect on patient care

10. Ex. 1: Human Resource Improvements Brainstorm solutions –Discussions with former volunteers education chair medical director current volunteers

11. Ex. 1: Human Resource Improvements Propose solution –Education chair proposes new training program 1.Half day lecture-style orientation with breakout sessions for individual roles 2.Mock clinic for introduction to clinic flow –Time line for implementation

12. Ex. 1: Human Resource Improvements Evaluate changes –Survey new volunteers About training experience About preparedness

13. Ex. 2: Patient Education Expansion Identify problems: –Nursing students not gaining practice-based learning experience –Underutilization of special services Mental Health Nutrition

14. Ex. 2: Patient Education Expansion Brainstorm ideas: –Large project headed up by PI Team Other stakeholders include –Nursing, nutrition, and mental health leadership –Operations team members –Survey of patients in clinic about preferred education methods

15. Ex. 2: Patient Education Expansion Propose solution: –New Clinic Education Team –Board then approves timeline and implementation plan Piloting changes Rollout with new volunteers

16. Ex. 2: Patient Education Expansion Evaluating changes: –Utilization of special services –Patient wait time –Volunteer satisfaction

17. Ex. 2: Patient Education Expansion

18. Total Patients Served Nursing education visits since November: 1-2 per night Nutrition education visits: 0-1 per night Mental Health

19. Ex. 3: P&T Committee Identify problem: –Poor formulary management –No standardization of pharmaceutical care –Poor pharmacy processes

20. Ex. 3: P&T Committee Propose solution: –Pharmacy volunteers propose formation of new P & T committee to board –Leadership agrees to planning committee Write mission and vision Select committee members Outline implementation timeline

21. Ex. 3: P&T Committee Moving forward: –Standardize clinical care plans –Update formulary according to best practices –Define criteria for dispensing a 90 day supply of medications

22. Ex. 4: Public Health Role Problem: –Public health students not gaining practice- based learning experience

23. Ex. 4: Public Health Role Brainstorm ideas –Discussions with public health students and public health faculty

24. Ex. 4: Public Health Role Proposal: –Human resources chair proposes new 2 nd year public health role –Board approves pilot project for 2011-2012 year

25. Ex. 5: Strategic Planning Committee Identify problem: –Good concept, poor execution Members lacked clinic experience Committee disconnected from clinic leadership Forced interdisciplinary component

26. Ex. 5: Strategic Planning Committee Brainstorm ideas –Discussions about how can we make this work current board members strategic planning committee members

27. Ex. 5: Strategic Planning Committee Solution –Have board members serve on committee

28. Process Improvement Themes Use problem solving strategies –Solve the right problem –Set reachable goals –Tie initiatives together Have an implementation process Involve all stakeholders in PI initiatives Create a culture that encourages everyone to participate in process improvement

29. Thank You