May 29, 2009 – Jill Wooldridge P.A.-C. Boynton Health Service, University of Minnesota, Minneapolis, MN

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May 29, 2009 Jill Wooldridge P.A.-C. Boynton Health Service, University of Minnesota, Minneapolis, MN Slide 2 Topics to be Covered: Define Convenience Care How we came to develop/improve Gopher Quick Clinic How Gopher Quick Clinic Functions Display data about utilization of GQC Impact on Providers, Primary Care, Urgent Care Financial Impact Future Considerations and Plans Challenges to the Model 2 Slide 3 CONVENIENCE CARE WHAT IS IT? Provides care for Minor Acute Illness (strep throat screens, bladder infections, sinus infections, warts, impetigo etc.), some basic vaccinations and basic testing. A Walk-in patient centered model usually staffed by Advance Practice Clinicians. Patients evaluate their own needs and pick care time that is convenient to their schedule. One Stop Care. Total patient interaction is in one location and usually a single face-to-face interaction with a single Clinician. Since the first Convenient Care clinics opened in 2000, the industry has grown quickly today approximately 1,200 such clinics are in operation (many in retail locations) 3 Slide 4 HOW WAS THE BOYNTON PROJECT IDENTIFIED? An effort to support the Universitys strategic mission to improve services to the student population. Community trends and patient expectations for more choice and control over how they access care and Boyntons and University Human Resources desire to meet these. An identified internal challenge in our current Urgent Care model to optimally serve acute care patients. 4 Slide 5 PURPOSE OF COMMITTEE October 10, 2006 - Committee charged by COO to evaluate: The benefits of providing a Convenience Care model of service. The appeal of Convenience Care to our patients and third-party payers. The impact of this service on Urgent and Primary Care. Over-all financial impact. 5 Slide 6 COMMITTEE MEMBERS Chair: Mary Alderman - Director Clinic Operations Co-chair: Dave Dorman Health Promotion Beverly Carpenter Administrative Assistant Joyce Fortier Executive Secretary Jill Wooldridge, PA Provider BJ Anderson, MD - Provider Britt Bakke - Marketing and New Program Development Paula Miller, RN Student Health Advisory Committee member Barb Rangel, LPN Supervisor Patient Assistance and Information Virginia Tranter, RN Lead Nurse Immunization Clinic 6 Slide 7 QUALITY IMPROVEMENT PROCESS DMAIC: DMAIC is a basic component of the Six- Sigma methodology (Business Management Strategy) - a way to improve work processes by improving efficiency and eliminating defects. In its methodology, it asserts that in order to achieve high quality business processes, continued efforts must be made to reduce variations. 7 Slide 8 DMAIC MODEL DEFINE PHASE: What are the issues and desires for improvement MEASURE PHASE: Data collection to direct improvement efforts ANALYZE PHASE: Clarify and identify root cause of issue IMPROVE PHASE: List of all potential solutions and their impact with implementation plan and milestones CONTROL PHASE: Pilot plan, process control, implementation of solutions and transition control plan 8 Slide 9 Define Phase COLLECTING THE VOICE OF THE CUSTOMER o Conducted informal focus groups with the Student Health Advisory Committee (SHAC). o Conducted informal focus groups with Boynton Health Service (BHS) staff: Providers, RNs, Pharmacy, Lab, Front Desk and Support staff. o Created open message board for comments from BHS staff on shared network drive. 9 Slide 10 Measurement Phase Measured interest in a Convenience Care model An online survey sent to 4,000 students, with a return rate of 32%, showed 68% were interested. An online survey sent to 2,000 faculty and staff, with a return rate of 38%, showed 53% were interested. 10 Slide 11 Measurement Phase (continued) PROBLEM: Urgent Care process of dealing with Minor acute illness is inefficient and lengthy for the patient. Measured current process efficiency for treatment of minor acute illnesses in Urgent Care. Urgent Care Cycle-time study: Urgent Care Provider Average Cycle Time = 80.5 minutes RN Average Cycle Time = 54.5 minutes RUC Average Cycle Time = 66.0 minutes 11 Slide 12 Measurement Phase (continued) Reviewed 12-Month (9/05 - 8/06) Total MinuteClinic Utilization U of M Student Benefit Plan (SBP) 61 visits U of M Graduate Plan 75 visits U of M Staff/Faculty Benefit Plans 1,885 visits Of the total Staff/Faculty MinuteClinic visits, 389 were seen at the Coffman site (just under 50/month). 12 Slide 13 Analyze Phase Analyzed results of student, staff and faculty online surveys. Reviewed list of factors identified in the formal focus groups. Performed a Root Cause analysis on current model of care. Consulted with Boynton Health Service Chief Operating Officer (COO) to examine fiscal implications of implementing a Convenience Care model. Toured the University of Minnesota Duluth QuickCare Clinic. 13 Slide 14 Improve Phase In March 2007 the Committee recommended that BHS provide a Convenience Care model service as a pilot, effective fall 2007. The service was named Gopher Quick Clinic. The hours of service were to be Monday through Friday, 9 a.m. to 5 p.m. with no coverage over the lunch hour (1-2pm). The service was not offered during holidays/breaks. Unless year-round fees were approved and a need for summer services was established, the service would not be offered during the summer. 14 Slide 15 GQC IMPLEMENTATION TEAM Chair: Mary Alderman - Director Clinic Operations Co-chair: Jill Wooldridge, PA Provider Britt Bakke - Marketing and New Program Development Margaret Dahl, RN - Nurse Supervisor Primary Care Davin Hedin - Principal Accounts Specialist Sue Jackson - Director Student Health Benefit Plan Amy Murphy Executive Accounts Specialist Barb Rangel, LPN Supervisor Patient Assistance and Information Deb Sandberg, MD Medical Director Karen Strauman-Raymond, RN Nursing Director Gina Tran Supervisor Patient Accounting 15 Slide 16 Improve Phase (continued) BHS Marketing Department implemented the Marketing Plan during spring and summer 2007. During March 2007 through August 2007 the Implementation Committee: defined flow and location of clinic, equipped and stocked the clinic, hired Advanced Practice Clinician providers (to split time between primary care and GQC) trained staff on new processes. On September 4, 2007 the new clinic service was opened. 16 Slide 17 Slide 18 Gopher Quick Clinic Services Gopher Quick Clinic is limited to addressing one of the following concerns per patient visit. 18 Common Illnesses: Bladder Infection Bronchitis Cold/Cough Ear Infection Laryngitis Mononucleosis Respiratory Flu (without vomiting or diarrhea) Seasonal Allergies Sinus Infection Strep Throat Swimmers Ear Skin Conditions: Athlete's Foot Cold Sores Impetigo Minor Sunburn Poison Ivy Ringworm Warts (three or fewer, does not include genital warts) Vaccines: Tetanus Vaccines (Td and Tdap) Flu Vaccine (when flu shot clinics not running) Additional Services Pregnancy Test Slide 19 19 Slide 20 Boynton Gopher Quick Clinic 20 Slide 21 HOW DOES IT WORK? FRONT DESK STAFF: Checks in patient, schedules them for next available slot (every 15 minutes), tells patient approximate wait time, gives them Short Health History form to fill out. Handles any co-pay/insurance issues 21 Slide 22 22 Slide 23 23 Slide 24 24 Slide 25 HOW DOES IT WORK? GQC PROVIDER (Team of 6 PAs, 2 NPs): Calls patient from schedule on computer, brings back to room Interviews patient (uses paper form) Obtains vitals (Spot Vital Signs) Examines patient Performs any point-of-care labs [Strep, Mono, Flu, Urine dip, urine pregnancy test; Throat cultures, Urine cultures sent to lab] Writes any Rx, educates patient, uses pt. education materials Patient leaves room, provider finishes any documentation 25 Slide 26 Boynton Gopher Quick Clinic Exam Room 26 Slide 27 27 Slide 28 HOW DOES IT WORK? MEDICAL RECORDS: Collects paper encounter forms daily Sorts for billing, clinical record Scans the paper visit for our EMR (usually within 1 day) Abstracts pertinent data directly into our EMR: Reason for Visit, Vitals, Labs done, Assessment, Medications prescribed (usually within 1-2 days) 28 Slide 29 Control Phase (Fall 2007) The week of October 22-26, 2007 BHS sent a survey to all current Gopher Quick Clinic patients to assess satisfaction with the service. Katie Lust, PhD, Director of Research and Surveillance, evaluated all surveys 29 Slide 30 October 2007 Survey Results Compare Satisfied vs. Not so Satisfied Satisfied = Excellent, Very Good and Good Not so Satisfied = Fair and Poor 81.2% of the patients surveyed rated the entire visit as satisfactory. Target is 90% satisfaction rate. Patient concerns identified were: 1) wait time in the lobby 2) time spent with the provider in the exam room 3) privacy 30 Slide 31 OCTOBER SURVEY PROCESS IMPROVEMENT PLAN WAIT TIME : Added appointments over the 1-2 p.m. lunch time Changed marketing material to indicate that GQC was: 1) first-come-first serve and 2) capacity for the clinic may be reached prior to the 5 p.m. closing TIME SPENT WITH PROVIDER: Changed marketing material to say Visits last approximately 10 minutes. PRIVACY: Performed a second survey asking more specific privacy questions Changed location of urine sample drop-off from Lobby to Front Desk 31 Slide 32 Control Phase (Winter 2008) On January 22, 2008 BHS sent a 2 nd survey to all current Gopher Quick Clinic patients to assess the following: Wait Time expectations Satisfaction with amount of time spent with the provider in the exam room Level of comfort with: 1) check-in procedure 2) location of waiting room 3) location of exam room Level of comfort with the process for giving a urine sample as it related to: 1) location of restroom 2) privacy of restroom 3) walking from restroom to drop-off box 4) location of drop-of box and overall urine collection procedure 32 Slide 33 JANUARY 2008 SURVEY RESULTS Compared Satisfied vs. Not so Satisfied Satisfied = Excellen