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Streamlining Clinical and Office Work - Milestone #22 (27 for Primary Care)

Learn strategies for meeting Milestone #22 (27 for Primary Care) in streamlining clinical and office work. Discover the importance of scoring for each milestone and its relevance to phases. Join the discussion.

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Streamlining Clinical and Office Work - Milestone #22 (27 for Primary Care)

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  1. TCPI Project Pathway: Session 5 of 8Streamlining Clinical and Office Work – Milestone # 22 (27for primary care)

  2. About the TCPI Milestones • 22 Milestones for specialty practices • 27 Milestones for primary care • Scores on each milestone determine Phase completion • For example, to complete Phase 1, as score of 3 is necessary on milestone 13 (setting an aim). • Other phases require various scores for other milestones.

  3. Milestone Classes Review Scoring and Strategies for Meeting Them (numbers in parentheses indicate milestone numbers for primary care) Each Milestone-Group Class will be held live 3 times: • Quality Improvement Strategies and Action –milestones 14, 15, 16 (19, 20, and 21) (already held- recording available) • Improvement Goals – milestones 1, 2, 3, 13 (1, 2, 3, 18) • Staff Engagement: Teamwork and Joy – milestones 6 and 19 (6 and 24) • Identifying Patient Risk and Using Best Practices – milestones 7, 11 (8, 9, 10, 16) • Streamlining Clinical and Office Work – milestone 22 (27) • Coordinated Care – milestones 8, 9, 10 (11, 12, 13, 14) • Person and Family-Centered Care – milestones 4, 5, 12, 17 (4, 5, 7, 15, 17and 22 for primary care) • Business Strategies – milestones 18, 20, 21 (23, 25, 26)

  4. Today’s Objectives • Review scoring for streamlining clinical and office work milestones: 22 (27 for primary care) • Outline strategies for meeting each of these milestones • Review relevance of milestones’ scores to phases • Open discussion

  5. Milestone 22 (27 for primary care): Practice has a formal approach to understanding its work processes and increasing the value of all processing steps. (A score of 3 is needed to complete Phase 4.)

  6. Your Transformation Workplan – Practice Plan Tab

  7. Strategies for Meeting Milestone 22 (27) Change Package – 3.4.1 • Train staff in lean approaches and the concept of value • Consider hiring or training internal experts in process improvement • Use lean principles across the organization, such a defining waste and identifying value through the patient’s eyes • Use process mapping to document workflows and identify value-add and non-value steps • Convene regularly to discuss and improve workflows to optimize use of the EHR

  8. What are my key processes? • Patient Scheduled Appt – Patient Checked Out • Same Day Appt Request – Patient Checked Out • Patient Admitted in ED – Patient Scheduled • Patient Seen – Pateint Discharged • Others?

  9. Process Mapping Helps

  10. Process Mapping Example with Swimlanes: PA Office Visit

  11. Practical Process Mapping

  12. What is Lean? What are Lean Principles? • Business and problem solving philosophy based on providing value through continuous improvement • The customer/patient comes first • Identify Value-added versus non-value added steps in a process • Improves Processes by Eliminating Waste

  13. 8 Types of Waste - DOWNTIME • Defects • Overproduction • Waiting • Not utilizing talent • Transportation • Inventory excess • Motion • Excess processing

  14. Strategies (continued) Change package 3.4.2 – Eliminating Waste • Use just in time inventory approaches • Standardize exam room set up and supplies • Optimize staffing on a daily basis to assure minimal down time of staff and space • Centralized stock formulaic ordering with multisite facilities • Establish pull production principles • Put supplies in kits when frequently needed together • Use spaghetti diagrams to track movement through the practice • Cross train staff • Standardize workflow across care teams and site where possible

  15. Strategies from Change Package 3.4.2 (continued) – Maximizing Provider Value • Integrate behavioral health • Reduce exam room interruptions • Use technology where possible to reduce effort required by staff • Use standardized approaches for scheduling • Translate productivity statistics to lost revenue to make the case to staff • Use protocols for non-licensed staff • Expand number of support staff per provider; evaluate the model regularly • Optimize number of exam rooms per providerUse productivity measures that include non-visit related care • Incent effective team-based care • Eliminate phones from exam rooms; knock if needed • Define use case for exam rooms (e.g. nurse visit) • Optimize exam room workflow • Use pagers for all staff to eliminate exam room interruptions • Create a compensation model that does not create barriers to change • Move from relative value unit-based compensation to relative value units plus performance metrics • Develop a walk-in care model • Adjust schedules to account for no show

  16. This Photo by Unknown Author is licensed under CC BY-SA

  17. Coming Next Week:Coordinated Care • Specialty milestones: 8, 9, 10 • Primary care milestones: 11, 12, 13, and 14

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