April 6, 2001

VMG prepares for clinic redesign

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Peter Buerhaus’ study reports that America’s pool of nurses is shrinking rapidly.

VMG prepares for clinic redesign

A clinic-by-clinic analysis is underway in preparation for operations improvement. First up are oral surgery, pulmonary medicine and ophthalmology. The redesign effort will focus on patient access and care delivery, and will be closely coordinated with the Vanderbilt Medical Group medical informatics project (E3) and the group’s ongoing front-end redesign initiative aimed at improved billing.

VMG Chief Operating Officer David Posch leads the consulting team for clinic redesign. For each clinic, the team will conduct interviews with faculty and staff and gather data on volume, access, telephone traffic and staffing levels; the study will also include detailed charting of patient flow processes and exam room utilization. Clinic managers and administrative officers will join in the work of the consulting team.

“The data will be summarized and fed back to leadership of each clinic in order to generate recommendations for improvement,” Posch said. “Later there will also be feedback to a broader sample of physicians and staff in each clinic, to gather more feedback and thoughts for improvement.” An action plan will then be devised for each clinic.

Within each clinic, the entire process is expected to take four or five weeks. The team expects to begin another clinic every two weeks. After six to eight clinics have formed action plans, a VMG retreat will examine system changes that would impact all clinics.

Doris Quinn, PhD, with the center for clinical improvement, will assist staff in the clinics to uncover details of their current operation, guiding each clinic to create a process flow chart detailing every step from taking a patient’s call for an appointment to completing the office visit. Quinn and others at the center for clinical improvement have created a process analysis workbook to guide teams in the clinics.

“Doctors, managers, staff – the people who do the work and know the processes best – are the ones who do the analysis,” Quinn said. Clinics will also be assisted by Racy Peters, VMG director of common systems, and John Hobby, VMG programmer/analyst, who will provide data on demand and capacity in each clinic. Dr. Rhea Seddon, assistant chief medical officer, will interview physicians. Managers and staff will be interviewed by Nancy Lorenzi, assistant vice-chancellor for health affairs from informatics, and Susan Cooper, administrative director of VMG network practices. Staff satisfaction surveys will yield additional information about the functioning of each clinic.

An important part of the analysis is demand for services, and whether each specialty has enough docs, staff and space to meet that demand.

The study of clinic operation will include details on the roles played by doctors, nurses, technicians, secretaries, etc., and the amount of time spent in each activity. In particular, they’ll examine whether a given activity is appropriate to the person’s level of training.

The search for improved room utilization starts with examining the volume and type of activity performed in each room of a clinic suite. Eighty-five percent utilization of exam room capacity strikes an optimum balance between efficient use of resources and preventing long stretches in the waiting room.

Joyce Thomas, a consultant with the center for clinical improvement, will help clinics sort out their phone traffic. It takes a bit of extra work for staff to keep phone logs, but it pays off in greater understanding of staff utilization and clinic operation. Given the lengthy waits for VMG appointments, it’s thought that many staff members are mired in rescheduling and other work that crops up because appointment backlogs are large. The phone logs will allow clinics to learn more about the impact of their appointment backlogs on day-to-day operations.

Patients will be asked to record the time spent in the clinic, from check-in to check-out. VMG has found that patients are generally happy to oblige with such studies.

“The analysis is only the first step,” Quinn said. With data in hand, each clinic will understand its current processes in detail and will be in a better position to avoid rework, eliminate unnecessary steps and generally improve efficiency.