Practice Management Scenario

PLAN: 1. Identify the Problem: Review the data regarding Standard County Health Department below. The health director is very concerned regarding the clinic budget: the agency lost $200K in 2013, $278K in 2014 and based on current productivity, is projected to lose $275-300K this fiscal year. The agency has exhausted 50% of their fund balance and the BOH is requesting an assessment and action plan in the next month.

2. Analyze Compare the data to benchmarks: what are your top two priority areas/programs and why?

What is your aim and how would you measure success?

Use Fishbone to determine possible root causes for low FNP productivity.

Discuss a plan for stakeholder input to validate your root cause analysis.

Clinic flow and scheduling are frequently issues for productivity: map the child health clinic flow process. Identify the beaver dams in the process.

The no show rate is 40% in child health; schedules are booked out one year in advance but there are reminder calls a week prior to the visit. Use 5 Whys to determine possible root causes for high no show rate.

Perform a gemba walk through the process: what questions would you ask clients and stake holders?

3. Generate solutions Brainstorm and prioritize possible solutions

4. Select solutions Develop a PDSA cycle for the top solution (use blank PDSA cycle). Standard County Health Department

Integrated Clinical Services:  Child Health (preventative & primary care): o 35% of total visits o 80% Medicaid  Family Planning: o 50% of total visits o 20% Medicaid  STD: o 15% of total visits o 5% Medicaid

Nurse Clinic: o 15% of total visits o 40% reimbursed services

Staffing: Integrated Clinic: 5 days/week 2 FNPs & one CH ERN 3 days per week Support: by 4 RNs and 2 CAs

Nurse Clinic: 5 days/week 1 RN provides immunizations, TB tests, pregnancy tests, nurse only visits

Admin Staff: 8 Clerical staff 2 Billing staff 2 Interpreters

Productivity: FNPs: Average 12 visits/day CHERN: Average 3 visits/day Nurse Clinic: Average 11 visits/day

Productivity benchmarks for MDs/FNPs/PAs = 20 visits/day; CH ERN benchmark = 6 visits/day; RN productivity = 20 visits/day