The QI Initiative focused on decreasing the time taken to register Family Planning clients, improving client and employee satisfaction with the appointment making process and wait times, and improving employee communication. Primary strategies included implementing a preregistration process [registering clients before they presented at the clinic when possible, goal 80% of clients], eliminating redundant work, creating training manuals and quick guides, creating a communication board to communicate changes, creating audit tools and sharing results, and starting weekly huddles. As a result, 60% of clients are preregistered, requiring on average 4-9 fewer minutes to register than non-preregistered clients [8-19 minutes vs 12-18 minutes]. Overall average time to register clients, whether preregistered or not, decreased from 15-50 minutes to less than 20 minutes. Client survey scores rating the appointment making process negatively decreased from 6.6% to 4.6% and negative wait time scores decreased from 20% to 9%. Employee survey scores rating the appointment making process negatively decreased from 57% to 24% but negative scores for wait times increased from 29% to 53%. 65% of employees rated communication positively. Accuracy of the registration process and communication among team members
improved and additional QI team members were recruited.

This QI project addresses Family Planning clinic cycle time, client satisfaction with the appointment making process and wait times, employee satisfaction with the appointment making process and client wait times, and communication among employees. Baseline time to register a Family Planning client ranged between 15 and 50 minutes. An appointment making protocol was available but was not being used. 19.8% of clients and 28% of employees reported negative scores for wait time. 6.6% of clients and 57% of employees reported negative scores for ease of making appointments.

Need for the QI Initiative

How was the need for the QI Initiative determined?
Since baseline data was collected on Family Planning clinic flow and a few strategies to improve clinic efficiency had been initiated, the QI team decided to expand on these initiatives. They selected to study and improve the intake process of registration because it was the first step in the registration process.

We aimed to improve the efficiency of the Family Planning Clinic by reducing intake process time to less than 15 minutes by February 1, 2014. This was important because it would improve Family Planning client satisfaction by decreasing negative survey scores from 20% to 18% for wait time and from 6.6% to 6% for ease of appointment making, decrease overall cycle time, and reduce stress on staff by establishing a consistent and reliable approach. Employee satisfaction goals were to decrease negative survey scores from 29% to 26% for client wait time and from 57% to 51% for ease of appointment making as well as improve communication scores. The target population was Family Planning clients and staff. We achieved the aim by analyzing existing processes and by utilizing LEAN methodology and QI 101 tools to simplify and standardize processes.

 

Project Dates

Initiative Begin Date: Nov 1, 2013
Initiative End Date: June 2013

 

Accreditation Status

Are you accredited by the NC Accreditation Program? Yes
Are you PHAB accredited? No
If no, do you plan on applying for PHAB accreditation? No

 

Clients and staff reported that clients were being processed more quickly, registration process was standardized,
professional development of staff, culture shift to fostering/supporting change, learning how to engage others,
recruited future QI team members, improved communication: huddles, communication board, training manual and
job aids, reduced paperwork and redundant tasks.

Areas for Improvement and Change Ideas Implemented

Improvement 1
Implement a preregistration process

Improvement 2
Improve consistency of the registration process by creating a training manual, job aid, check lists, and conducting audits to identify error rate.

Improvement 3
Improve communication among staff regarding changes by conducting huddles and using a communication board.

Improvement 4
Introduce the concept of QI into the culture and fostering an atmosphere that embraces change and freedom to 'test' ideas.

Lessons Learned

• Conduct the Kaizen event earlier on in the process.
• Advertise and celebrate successes.
• Allow time for staff to experience positive results of change.
• Recruit next team members while the project is being conducted.
• Expect resistance.
• Communicate: listen to unspoken messages from frontline staff.
• Use and adhere to meeting agenda formats.

Other Information

• Include the supervisor of the affected project area early on in the process if they are not already directly involved.
• Be patient: the QI team was losing hope that improvements could be made just when the frontline staff was getting on board.
• Persevere and foster a 'willingness to try' attitude to overcome resistance to change.