From: Consultant A, PMII
Re: Proposal to Improve Performance at University Health Services Clinic
After reviewing the data you have given me, I decided on the following measures to ensure the UHS Walk In Clinic runs more efficiently while at the same time providing a pleasant experience for patients. The switch to the triage system has succeeded in decreasing the overall wait time, however there is room for improvement. I recommend concentrating efforts to improve services in three critical areas (please refer to attached flow chart):
1. The Moment of Truth (MOT) when patients first arrive at the clinic. This is critical because the first moments when patients arrive are the most important for making their visit feel reasonable. Patients now wait 19 minutes to see a triage nurse. It is possible with minimal resources to improve the quality of this initial wait time. For example, the receptionist can request the patient’s records while the patient is filling out the AVF in the waiting area, both giving the patient something to do while waiting and speeding up the record retrieval process. The waiting room should be pleasant, with current magazines regarding health and chairs comfortably spaced.
2. The problem of physicians being occupied with regular patients during assigned walk in clinic hours. With the switch to the triage system, physicians are seeing 48% of patients who enter the clinic. Meanwhile, more than a third of physicians are 100% occupied with pre-set “appointments”, creating an unbalanced utilization of staff and a bottleneck for patients waiting for physicians. If physicians are freed up to really serve the purposes of the walk in clinic, then overall processing time will decrease. I recommend you approach this problem from a few angles: • Physicians should be confronted to determine root of the problem. If the problem lies with their inability to meet demands for individual appointments, then the issue must be dealt with using the support of Sholem Postel, MD, the chief administrator of professional services. • Clinic must be advertised as walk in only, to deter users from requesting specific providers. Implement with brochures, signs, online resources, and verbally by nurses and physicians. • If the problem persists, consider a no-request policy during peak hours.
3. The percent of patients seen exclusively by a nurse practitioner. It was expected with the change to a triage system that NPs would see more patients through the process, however NPs now see fewer patients. As of now, patients waiting to see a NP only wait 7 minutes after seeing the triage nurse. Total processing time will decrease if more patients are seen through the system without the need to see a MD. This would also alleviate some of the stress from physicians being occupied with regular patients. To implement this, triage nurses need to be well trained in assessing patients and if in doubt, send patients to an NP first. I also recommend following through with the expansion of nurse practitioners’ ability to treat a wider variety of problem. Current Process Flow Chart for UHS Walk In Clinic Triage System: |Patient enters walk in clinic |Triage nurse meets with patient|Patient waits to see NP or MD |Patient sees NP |Patient sees MD |Visit is Complete average of | | | | |28% of patients |48% of patients |37.5 min. wait | |Wait time: 19.7 minutes |Triage: 3.5 min. | | | | | | | | |Emergency: Patient sees...