Educator Roles: Highest and Best Use of Resources

Time Management Tools Educator Roles: Highest and Best Use of Resources Educator, Clinician, Coordinator, Consultant, Case Manager

 Teach patients self-management skills  Help patients evaluate their self-management  Encourage and support patient behavior change  Update patients on new therapies/options  Identify community resources for patients  Educate PCPs & community on the role of the educator  List other essentials of the educator role ______Purpose of an Educator Time Study As a busy educator you are probably frustrated when you are told your program is losing money. A time study is a tool to identify how you are spending your time. It will help you identify activities that impede your ability to see patients. Once you identify impediments, you can work with your manager to determine what activities can be eliminated or done by a less expensive resource in order to allow you to fulfill the educator’s mission, to teach patients. An alternative outcome is that your manager will recognize that the impediments to teaching patients actually support other organization needs. The support you provide to other parts of the organization may be able to be charged to other departments. Steps to Complete an Educator Time Study 1. Pick a date to start the time study. Select a 1-week period that is typical, not one with staff on vacation or when your team is implementing a new initiative. 2. Review the forms and definitions with all educators on your team. 3. Determine which categories of “Other” are most common at your site. Try to avoid using a general “Other” category. Add more columns/categories to the form if you feel that is necessary. 4. Provide 1 form/day worked/educator. 5. Record activities as you go through your day rather than at the end of the day to improve accuracy of the record. 6. Round time to 15-minute intervals and record in minutes. Remember you can only bill DSMT in 30-minute increments. 7. Note “no-show” and last minute cancellation time to allow you to evaluate how big that problem is. 8. Complete totals at the bottom of each page each day. 9. If you work different hours than are listed in the left column, adjust the time to your schedule. 10. See the Educator Time Study Summary Sheet attached for steps to analyze data. A clerical person can be assigned to complete the table following steps of analysis #1 and #2. The educators should meet as a team with the manager to discuss steps #3 – #6. 11. Develop a CQI plan to address problems identified by the time study. 12. Re-evaluate with a subsequent time study.

Check off the activities that are part of your normal routine. Determine as a team the categories you will include in your time study to avoid having too much time in an unidentified “Other” category.

Direct Care/Face-to-Face time  Group – face-to-face time spent teaching class  1:1 visit – face-to-face time spent in individual visit  No show/Cancel – time that you were scheduled to see patients but they didn’t show up or cancelled too late to book someone else in

Other Tasks  Charting* (report here if not done during patient appointment) – reviewing medical records, documentation, letters to physicians, reviewing BG and food records, downloading meters and reviewing  Phones* (report here if not done during patient appointment) – checking voicemail, making and receiving calls *Note: The most cost effective practice is to do charting and phone calls regarding the patient during the visit and include it in billed time.  Meetings - formal & informal meetings including travel time; staff meetings, case conferences, “curbside” consultations, precepting/orienting new staff or students, meetings with referral sources, community programs and outreach, marketing calls, professional development, discussions with pharmaceutical/meter representatives, etc.

More “Other” Tasks (Pick 3 categories most common to your site; if you need more than 3 put several similar activities in 1 category or add columns to the Educator Daily Record)  Preparing for groups – class set up & breakdown  Program development – development of educational tools such as curriculum, meal plans, hand outs or presentations  Triage –urgent front desk or walk-in requests (try to turn walk-ins into billable visit and then count it in 1:1 visit category); reviewing referrals; calling/faxing referral sources for additional information  Clerical tasks – copying, filing, answering non-clinical calls, faxing, looking for missing medical records, front desk support, scheduling appointments  Email/ Mail – reading and writing emails, reading “snail” mail  PCP/Endocrinologist support – non-billable time spent doing activities the patients physician would otherwise have to do including processing prescription refill requests, adjusting insulin by phone, CGM analysis  Inpatient support – time spent traveling to and from inpatient units, training inpatient staff, providing non-billable inpatient education  Other – activities that do not meet other descriptors – should be detailed in comments section

Lunch/breaks – Count in your total time only if it is part of your paid time

L/AADE Learning modules/St Louis 2007/Handouts rev 04 24 07 Copyright © 2007 by Joslin Diabetes Center, Inc. All rights reserved Educator Daily Record Date: ______Scheduled work hours: ______Actual Hours worked: ______Typical Day ___Y ___N

Time Direct Patient Care Charting Phones Meetings Other (Specify categories) 1:1 Group No show/ cancel 8 am

Total:

Comments: ______

______

Educator Total Hrs 1:1 Group % Direct No show/ Charting Meetings Phones Other 1 Other 2 Other 3 Worked Hrs (%) Hrs (%) Pt Care cancel Hrs (%) Hrs (%) Hrs (%) Hrs (%) Hrs (%) Hrs (%) Hrs (%) Hrs (%) 1 2 3 4 5

Steps of Analysis: 1. Tabulate the findings and convert to hours by dividing total minutes by 60, i.e. 600 minutes in 1:1 appointments/60 minutes per hour = 10 hours on the Analysis grid 2. Calculate percent in each category by dividing hours in the category by total worked hours, i.e.  10 hours of 1:1 appointments/ 40 hours worked = 25% of worked time in 1:1 appointments  8 hours of group/40 hours worked = 20% of worked time in group  25% (1:1) + 20% group = 45% of worked time in direct patient care 3. Analyze a. Does the category support the educator’s role? b. Does the category impede the educator’s role? c. Is the time spent the best use of educator resources? d. Could a less skilled/less expensive staff person perform the task? 4. Plan a CQI project based on time study results 5. Act 6. Evaluate

Copyright © 2007 by Joslin Diabetes Center, Inc. All rights reserved Sample Joslin CQI reporting form: CQI team leader:______Team involved in the CQI study:______Date of the CQI study: from ______to ______Title of project:______

What was identified as the “problem” you chose to study? What data did you collect? Did the data confirm that it was, in fact, a problem? What analysis did you make of this data? What are the some of the possible “solutions” or actions your team thought of to address this program? Which solution did you choose to implement and why? How did you implement this plan? What did you learn from this implementation process? Reevaluate the problem. Collect data and analyze it to see if your solution produced a measureable improvement. What was learned from this process? What is your plan to continuously check on this to make sure the improvement is maintained, or if there was no improvement – to pick another solution to try?