1. SFGH Children’s Health Center Quarterly Report, June 2011 CHC Stats 12,700 patients 16,000 primary care visits annually Provider FTE NPs: 2.24 FTE MDs: 1.73 FTE Residents: 1.89 FTE MEA/LVN FTE 4.0 MEAs + as needed 4.5 RNs 3 LVNs (1 currently on leave) 2 clerks and 1 senior clerk We have 7.6 FTE and need 8.5-12.75 FTE! The Children’s Health Fairies Lannie Adelman, RN, MS, MBA Shonul Jain, MD Shannon Thyne, MD Katie McPeak, MD Mabel Chan, MD Jennie Trinh

2. Aim Statement ACCESS IMPROVEMENT: – Ultimate goal of increasing patient visits – Route to improvement is through streamlining/shortening the patient visit AIM STATEMENT: “ For primary care patients, decrease total patient time at clinic visits (including registration, clinician time, immunizations, and labs) to <90 minutes per patient by January 1, 2012.”

3. Changes tested or implemented this Quarter PDSA summary and learning points – Huddles  need more clinician buy in and MEA supervision/training  leadership change/clearer messaging – MEA checklist  not completed by MEAs/not valued by clinicians despite group consensus on implementation  more training and supervision for MEAS, clearer expectations for clinicians and MEAs – Staff satisfaction survey  staff generally happy but different sense of purpose than clinicians  work on teambuilding  repeat survey in June 2011 – QI training  team workshop  QI projects for MEAs, refined clinic-wide QI plan (SFHP PIP in summer 2011) REAL TIME CHANGES ON A DAILY BASIS IN THE CHC!

4. Data MEAs enter PCP at registration

5. Challenges Morale and buy-in – Role clarification Lack of leadership skills within primary care nursing team – Lack of larger vision “It’s just more work for us.” “That’s not my job.” – Resistance to change “That’s not my job.” Data – Measures difficult to determine – Collection Where is it? How do we do it? – Analysis Time

6. Action Plan Sustainable data collection – Measuring cycle time for all primary care – No show rates – Monitoring performance of MEA team in patient assessments – i2i and IT services for ongoing measurement Improve morale and buy-in – Customer service training – Create photo board for all staff – Incentives for improved performance – Examples of successful implementation (visits to other model clinics) – Repeat satisfaction survey Longer term “access”-related goals – Revise provider appointment templates – Revise immunization forms – Decrease no-show rates