Sfgh children s health center quarterly report 2 september 2011
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SFGH Children’s Health Center Quarterly Report # 2, September 2011. The Children’s Health Fairies Lannie Adelman, RN, MS, MBA Shonul Jain, MD Shannon Thyne, MD Katie McPeak, MD Mabel Chan, MD Jennie Trinh. Aim Statement. Original AIM Statement

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Sfgh children s health center quarterly report 2 september 2011
SFGH Children’s Health CenterQuarterly Report # 2, September 2011

The Children’s Health Fairies

  • Lannie Adelman, RN, MS, MBA

  • Shonul Jain, MD

  • Shannon Thyne, MD

  • Katie McPeak, MD

  • Mabel Chan, MD

  • Jennie Trinh

Aim statement
Aim Statement

  • Original AIM Statement

    “For primary care patients, decrease total patient time at clinic visits (including registration, clinician time, immunizations, and labs) to <90 minutes per patient by January 1, 2012.”

    • Ultimate goal of increasing patient visits and therefore improving access

    • Route to improvement is through streamlining/shortening the patient visit

    • Focus on improving communication/efficiency through use of huddles & pre-visit preparation (checklists)

Changes tested or implemented this quarter
Changes tested or implemented this Quarter

  • Multiple PDSAs refining a checklist as tool for huddle

    • Feedback from MEA and MDs leading to simplified check list (see next slide)

  • Multiple PDSAs refining Huddle process

    • Process is not empowering the whole team – maintaining MD-centered care

    • Huddles don’t work when “we don’t have enough hands”

    • “When I arrive, there is not someone there who is assigned to me. I would like to have the same person throughout the entire clinic.”

    • Schedule variations are impeding huddle capacity

  • Learnings from PDSAs

    • Our original concept of a huddle may not work.

    • The checklist is a helpful tool, but the most important part of team “huddle” is the preparation and open communication between providers and staff.

    • Need to continue to facilitate “prepping” prior to clinic.

    • Need to facilitate the ability to have a time in the beginning of clinic to communicate with each other.

  • Sfgh children s health center quarterly report 2 september 2011

    Changes tested or implemented this Quarter

    • Other Changes Implemented

      • Modified MEA schedules to improve staff ratios

      • Added “RN leader” to group of primary care MEAs to help problem-solving and team efficiency

      • Charts being available the day prior to clinic for “prepping”

      • Focus on communication:

        • Created posted schedule display to help anticipate busy clinic days

        • Increased frequency of staff meetings & check-ins to disseminate information and solicit feedback

        • Created clinic “face sheet” to help with name recognition and staff communication

        • Data Wall to show progress

    Data access measures
    Data – Access Measures

    # of days

    # of days

    Data empanelment
    Data - Empanelment

    Total % of Patients Unassigned to PCPs

    Total % of Patients Unassigned, by Age

    Data cycle time
    Data – Cycle Time

    Average time from arrival to departure whole clinic

    Time for Each Component of Patient Visit




    • Difficult to communicate change

    • Continued problems with morale and buy-in

      • Short staffed

      • Resistance to change

        • Providers not arriving on time; people still doing things their own way

  • Unique aspects of our clinic

    • Busy drop-in urgent care

    • Academic site with trainees

  • Some issues more difficult to fix

    • SPACE

    • Limited budget to hire new staff

  • Action plan for next 6 months
    Action Plan for Next 6 Months

    • Where we hope to be:

      • Revised immunization form to streamline vaccine ordering

      • Hiring data coordinator to help with collection/dissemination

      • Panel manager

      • Schedules modified to allow providers to attend teaching conference; have all the MEA’s present at the start of clinic and having designated time for group “huddle” prior to seeing patients.

      • Regular all-staff meetings

        • Annual all staff retreat

    Lessons learned
    Lessons Learned

    • Original concepts aren’t always right.

    • Large changes can require multiple smaller adjustments prior to achieving the ultimate goal.

    • A lot can be learned from doing small tests of change.

    • Input and involvement from all staff is important.

    • We realize the importance of accountability.

    • Communication is the key!

    • Change is good but it takes time and energy.

    Team growth
    Team Growth

    • We function better as a core team in the following ways…

      • We all share a common goal and vision.

      • We have realized each others strengths and assigned task appropriately.

      • We communicate better.