Phoenix, AZ September 20, 2006 Presented by: Anne Elam, RN, MPH, VA Department of Health Shelley Miller

1.  Phoenix, AZ September 20, 2006 Presented by: Anne Elam, RN, MPH, VA Department of Health Shelley Miller, MS, TRAINING 3, Family Planning Council, Philadelphia, PA

2. Brief History VA Dept. of Health had used PFA (DOS) in the past, early 1990s, with success Patient Flow Analysis focuses on clinic efficiency and improvement Time to re-evaluate clinical settings � supported by site visit by OPA 

3. Issues we hoped to Explore: Clinic Waiting Time Utilization of Staff Flow of Services Secondary By-product: Greater Staff Satisfaction Decrease Patient Frustration

4. How We Got Started �. Staff from Title X sites were selected by VA Dept of Health to participate in the trainings Teams (pairs) were selected representing each region/county from throughout VA (managers/technical skills) Each training consisted of: Two � 2 day trainings which were delivered to all selected providers. A total of 5 TOP trainings were delivered to a total of 66 providers from March 2005 � August 2006 By the end of August 2006, 33 teams of Title X providers from throughout VA were trained and conducting PFA studies with staff

5. Overview of the Process At the request of VA Department of Health, Title X grantee, TRAINING 3 contracted with PFA consultant, Brian Senecal, to develop comprehensive plan to train providers throughout VA on the utilization of Win PFA TRAINING 3 completed one �on-site� comprehensive WinPFA with the Petersburg health center in VA � Feb/March 2005 The materials from this study were used throughout the trainings that followed The first Training of Providers (TOP!) was delivered: Part 1 - March/Part 2 - April 2005

6. Train the Providers Part 1 The first 2-day training was held in a computer lab (local community colleges provided low cost and quality facilities)

7. Train the Providers Part 1 Design of the training included: History of PFA and Why do PFA Purpose of PFA: What it Does & Does Not Do PFA Output: Review of reports of graphs Overview of the PFA process Hands on skills Review & development of forms Data collection Visual edits Data entry Producing Reports & Graphs Preparing for the orientation and study Conducting the study

8. What PFA Does Do Identifies show rate Client time in the clinic and with staff Waiting time between stops (bottlenecks) Lost clients Staff time available and service time Time clients spend at each stop Personnel costs Visit types

9. What PFA Does Not Do Determine solutions What staff and clients were doing during contact time If personnel costs are reasonable If waiting time was reasonable The quality of services provided The quality of staff performance

10. Review of PFA Forms Codes and Labels Staff Worksheet Clinic Register Staff Register Staff Non-contact and Unavailable time Client Register Client Non-contact and Unavailable time Client Sign-in Sheet

11. Modified Client Register

12. Computer Skills Accessing WinPFA Data entry Editing/correcting errors Printing reports Printing graphs

13. Planning the Study Each pair was expected to complete a PFA study, including: Developing forms Orienting Staff Completing a study Enter data and print reports and graphs Bring copies of materials to Part 2

14. Important Reminders Study coordinators will set the tone for staff attitudes about PFA PFA �is not a monitoring tool� Keep it simple! There are resources available for any questions

15. Training of Providers: Part 2 Part 2 took place 4-5 weeks after the first training Participants brought with them copies of their reports and graphs

16. Part 2 How to interpret the reports (12) and graph Developing an Action Plan Working with staff Practice sessions

18. The Graph

19. Developing an Action Plan Post selected results for staff to review � within several days of study Schedule staff meeting (not more than 1 � hours in length) within a week of study Explore what is working well and identify challenges Brainstorm ideas to resolve challenges identified Develop solutions that could work Using reaching consensus technique select 1 � 3 solutions to implement Assign tasks Develop time line (including when the follow-up study will be performed) Repeat PFA as designed in time line

20. Observations from site visits Staff Cooperation Changes in Scheduling Practices Changes in Clinic Flow Confirmation and Statistical Data Anecdotal stories

21. Where Do We Go From Here Share Best Practices Evaluation of the Project Provide a Review a. Computer Techniques b. Data Analysis c. PFA Graph

22. Contact Information Anne Elam (804) 864-7754, anne.elam@vdh.virginia.gov Shelley Miller (215) 985-2645 Shelley@familyplanning.org CDC: Bill Boyd 770 488-6301 WAB2@CDC.gov www.cdc.gov/reporductivehealth/Products&Pubs/PFA_support/index.htm