Patient Flow and Clinic Efficiency Study
Boston University OM726 Operations Management
Ryan Evans Shailan Lala Sean Maher Chris Powers
To ascertain data and make recommendations to improve the efficiency of the patient flow with the VSSC goals in mind.◦ Volume, Safety, Satisfaction, Cost (VSSC)
In order to reach the objective, a time-effectiveness analysis was conducted through capturing patient times in the BMC Infectious Disease clinic.
Study Objective
•Project Management
•Organization
•Analysis Methods
•Process Analysis
•Feedback
•Recommendations
Presentation Overview
Task Best Estimate Complete Interval (Days)
Visit Clinic & Meet Staff 1
Develop Template for Observation 5
Perform Observations 5
Analyze Data 10
Draft Paper 17
Draft Presentation 13
Finalize Paper 7
Finalize Presentation 7
Deliver Final Paper & Presentation 1
Project Management
Project Management
Develop template
for observation
(5 Days)
BMC Clinic Observatio
n
Visit Clinic & Meet Staff
(1 Day)
Perform Observation
s(5 Days)
Draft Presentation
(13 Days)
Draft Paper(17 Days)
Analyze Data
(10 Days)
Finalize Paper
(7 Days)
Finalize Presentation
(7 Days)
Deliver Final Paper
& Presentation
0,0 0
0,0 0
5,5 0
10,23 13
0,0 0
5,5 0
10,23 13
0,4 4
1,5 4
10,10 0
40,40 0
40,40
20,33 13
20,33 13
23,33 10
10,10 0
40,40
33,33 0
30,40 10
33,33 0
20,33 13
03/06/09 04/15/09
Critical PathNotes:
The Organization
Clinic Type
HIV clinic Walk-in and Appt.
STD clinic Walk-in
Travel/Infectious Disease Appointment only
Refugee Appointment only
HIV/Substance Abuse * Appointment only
HIV/Pulmonary * Appointment only
Clinics Offered at BMC ID
* Indicates no data collected
Hours of Operation
Weekly Clinic Schedule
Monday Tuesday Wednesday Thursday Friday
Morning Hours 8:00AM - 11:00AM 8:00AM - 11:00AM 8:00AM - 11:00AM
Afternoon Hours 1:00PM - 4:00PM 1:00PM - 4:00PM 1:00PM - 3:00PM 1:00PM - 4:00PM
Evening Hours 4:30PM - 7:00PM
Clinic Types STDTravel
STDHIV
Hep. CSTD
Travel
STDHIV
Hep. CRefugee
STD
Primary FunctionsFunction Activities
Screening Help patients to determine if they have a disease through blood testing
Treatment Medical and Psychiatric treatment
Counseling • Inform travelers going to foreign countries on how to avoid illness
•Consultation for those newly diagnosed with illness, such as HIV
Research Academic studies at BMC
Measurement Objective
Volume Maximize throughput of the clinic
Safety Protect patients and staff from hazards
Satisfaction Send patients home content with service
Cost Minimize waste, maximize resources
Objectives - VSSC
StaffingStaffing Level Data Notes
Front Desk 2Check patients into the clinic, make appointments, and verify insurance information as well as other administrative functions
Medical Assistants 2 Call patients into the clinic, checks vital signs, makes follow up appointments
Team Coordinator 1 Manage front desks and paperwork
Phlebotomist 1 Draw & Analyze Blood
HIV/Travel Clinic Nurses 4 Perform and assist in examinationsSTD Nurses 3 Perform and assist in examinations
Clinician (MD) 26-30Perform examinationsEach MD only works a single AM or PM shift or a single day in the clinic per week
Case Managers 6 Provide STD & HIV counseling on a full-time basis
Methodology
Study objective Observe the patient flow throughout the process and
measure relevant task/wait times Process broken into two portions:
◦ Front of House: Check-in and waiting area Sample size n=91
◦ Back of House: Clinic area Sample size n=38
Two observers, one in each area◦ Clinic observer follows patient through each process
Study Design and Methodology
10 hours of observation◦ 6 hours morning clinic◦ 4 hours afternoon clinic
Quantitative data◦ Task times and process flow
Qualitative data◦ Feedback from clinic staff◦ Feedback from patients in waiting area
Data Collection
Process analysis
Data and Analysis
Performance StatisticsWait Area Min Task Time Max Task Time Avg. Task Time Cycle Time Capacity /
HourCapacity
Utilization
Get Number From Front Desk 0 545 32 303 11.00
Check-In Confirmation 0 900 123 302 11.00
Enter Clinic 0 4,455 1,981 377
Wait Area Totals - - 2,136 377 11.00 72.73%
Clinic Area Min Task Time Max Task Time Avg. Task Time Cycle Time Capacity / Hour Capacity Utilization
Vital Signs 120 1,534 295 587 24.00 33.33%
Time Spent with RN 160 4,990 1,325 716 8.00 100.00%
Time Spent with MD 608 5,694 1,641 615 8.00 100.00%
Phlebotomist 115 1,182 106 307 33.00 24.24%
HIV Counseling 375 760 64 N/A N/A N/A
Clinic Area Totals - - 3,431 716 8.00
BMC Travel & ID Clinic - - 5,567 716 8.00
* Times are in seconds
* Capacity are adjusted for average staffing levels
Patient Count/Hours vs. Clinic Capacity
8AM-9AM 9AM-10AM 10AM-11AM
1PM-2PM 2PM-3PM 3PM-4PM0
2
4
6
8
10
12
14
Patient Count / Hour vs. Clinic Capacity
Avg. Daily Patient CountCapacity
Staff Identification of Inefficiencies
Patie
nt b
ehav
ior
Check
-in a
nd w
aitin
g pr
oces
s
Differ
ing
prac
tice
styl
es o
f doc
tors
Lack
of r
esou
rces
Lunc
h br
eaks
slow
pro
cess
Need
to o
verb
ook
mor
e
Need
to o
verb
ook
less
0
1
2
3
4
5
6
7
Staffs Identification of Inefficiencies
# Of responses
Patient Identification of Inefficiencies
Confusion of check-in procedure
Long wait times Low staffing levels Ineffective use of idle time
No indication of wait times
0
1
2
3
4
5
6
7
Patients Identification of Inefficiencies
# Of responses
Recommendations
Reduce cycle time:◦ In response to the complaint that inefficiency is caused by
differing practice styles of the doctors Variation of task time time patients spent with doctors, which
ranges from 5,693 seconds (max) to 608 seconds (min) with a mean of 1,641 seconds.
MGH /CABG procedure:◦ Personal nature of medical practices versus systematic
standardization and guidelines for physicians. Benefits:
◦ Costs declined as doctor’s (time) variations reduced
Recommendations
Increasing time (labor) available:◦ When waiting room is operating over-capacity and the clinic is
operating under capacity that staff from the back of house assist in stabilizing the inflow of new patients in the waiting room
Task shifting:◦ Where tasks are moved to less specialized health workers.
Benefits:◦ “All hands on deck” sense of teamwork◦ Creating cross-skill functionality ◦ Reduce check-in times as the greatest bottleneck◦ Heightened patient satisfaction
Recommendations
Shifting demand:◦ Current demand exceeds capacity (early morning hours and
late afternoon) ◦ In-clinic advertising campaign
Signage informing patients when the best time of the day is to come for a lesser wait
Benefits:◦ Patients more aware of waiting times◦ Change behavior to set appointments to avoid waiting
Recommendations
Continue data collection within the clinic:◦ Determine patient demand patterns◦ Appointment no-show percentages◦ Clinic cost-effectiveness and ◦ Other efficiency measures
Benefits:◦ Accurate measurement lead to evidence-based decisions◦ Promote better management◦ Reach VSSC goals
Recommendations
Our team would like to extend a special thanks to Drs Metti Kanno, David Hamer and the BMC Infectious Disease Clinic staff for facilitating and supporting this project.
Questions and Answers
Acknowledgements