Jachson 5 - Improving Clinic Flow

• Details
• Last Updated on Tuesday, 23 April 2013 17:17

NAME OF HEALTH DEPARTMENT: JACKSON COUNTY DEPARTMENT OF PUBLIC HEALTH

PROJECT TITLE: JACKSON 5- Improving Clinic Flow

PROJECT TEAM LEAD AND CONTACT INFO:
CLARISSA ASHE
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828-587-8255

Project Overview

Project Aim:

Jackson 5 aims to continue to improve clinic flow by identifying procedure consistency and decreasing total client wait time for the Jackson County Department of Public Health clinics.  Lowering client wait time for all clinics will increase client and staff satisfaction. 

Goals:

• Decrease non-value added forms/steps.
• Increase staff satisfaction with clinic flow due to consistency.

Project timeframe:
Project is continuing from QI wave with expansion of all clinics.  QI is an ongoing process unsure of end time.

How was the need for the project determined?
Team strives to continue QI efforts.  Our main goal is consistency.  Team discovered many inconsistencies and aim to find the best possible procedure for our clinic.

Does this quality improvement project link to accreditation?
Yes because Team is updating policies making sure policies exist and are followed.

Areas for Improvement and Change Ideas Implemented

Improvement 1
Each clinic is different in how many forms are required.  Team looks at each clinic (so far just Family Planning and some Adult Health) and meets with Program Manager to insure all forms are updated and are in fact needed. 

• Team found that old and new forms were being used.  Team 5S’d forms and implemented that the Forms Master be responsible for maintaining and updating forms. 
• Team updated the Notice of Privacy Consent, this form needed to be revised in order so that client only signed once.  This form is also available in Spanish.  This particular form is now English in front and Spanish in back.  Less hunting and more efficient.

Improvement 2
Inventory Control was HUGE for us.

• Team discovered a lot of waste and inconsistency with inventory procedures.
• Team 5Sed inventory supply closets, orange dotted items only found in specific areas, and appointed an inventory control person. Already Health Department has seen less spending.

Improvement 3
Team eliminated work duplication. 

• Through Gemba walks Team noticed that client was asked demographic questions at registration, by MA and by RN who did history.  Also it was noticed that client had to leave exam room in order to receive immunizations.
• Family Planning patients were mailed history questionnaire, face sheet (demographics) and appointment reminder.  Client was specified to bring forms to appointment in order to reduce appointment time.  Registration makes sure face sheet is in chart so MA and RN are not asking same questions.   If client required immunizations RN gave immunization in exam room.

Improvement 4
Team implemented morning Huddle meetings with front office staff/supervisor and clinic staff/supervisor.  Supervisors were given a Huddle agenda with information deemed necessary for staff. 

• Team conducted Huddle meetings for the first week and blocked 8:00am so everyone had time to Huddle and register walk-ins before 8:20am appointment came in.   Since Huddle PDSA worked it was implemented.
• Supervisor is to inform staff of day events, who is out sick or who is leaving early, assign back up for staff that is out, answer brief questions staff may have and simple have a face to face meeting with staff.

Results

Overall Improvements

• Targeted non-value forms, tested consistency of clinic flow, created a clinic routing sheet to help with flow and record times,  assigned a forms master person, assigned an inventory control person, 5Sed forms and inventory, implemented Huddle meetings, red out-guide for all charts that are pulled from file room.
• Insert any charts, graphs, pictures, and quotes that show your changes led to an improvement.
• Team found that policies and procedures were not being followed. 

Lessons Learned

• Signage PDSA did not work well for our clinic, assigning two accounts receivable did not work well because of the layout of our clinic.  Team plans on involving more staff members next time.  Team tried but maybe a different approach would help next time.  Team feels Staff morale needs to be boosted.
• Team wishes we would have known how time consuming project was going to be.  Team had to keep up with QI and regular work since duties were not reassigned.  Overall QI has been very difficult but Team feels good about progress.