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Analysis of the VUMC Oral Analysis of the VUMC Oral Surgery Clinic: Surgery Clinic:
A Systematic Approach to Determining Clinic Access &
Efficiency and Space Requirements
Shiv Tumkur & Purnima Patel
Advisor: Dr. Doris QuinnApril 6, 2001
BME 273
MotivationMotivation
VUMC is expanding, and its clinics are finding the need to accommodate increasing demand requirements
Future of Clinical Practice in The Vanderbilt Clinic in 2003 E3– Patient View– Clinician View– Support System View
TVC Clinic RedesignTVC Clinic Redesign
Interpersonal
Procedures
Roles
Structure
Goals/Mission
Establishing the E3 VisionEstablishing the E3 Vision
Pilot program with the Oral Surgery Clinic
A complete analysis that:– Defines the work of
practice– Develops a team to
matches that work– Determines optimal
resource use
The Oral Surgery ClinicThe Oral Surgery Clinic
Focus– Diagnosis/treatment of jaw and facial
deformities as well as oral cavity pathology
Clinic leader: Dr. Scott BoydInformal Leadership: Drs. McKenna and
WertherLocated on 1st floor of TVC at VUMC
Path to Clinical ImprovementPath to Clinical Improvement
Clinical Improvement
Demand Analysis Capacity Analysis
Process Analysis Space Analysis
Demand AnalysisDemand Analysis
Demand is a patient’s need for clinical services
Identify physical locationIdentify the current human resources
available Future growth potentialSummation of internal and external demand
‘true demand’
Capacity AnalysisCapacity Analysis
Capacity is the ability to meet the needs of patients seen in clinic
True measure of delay: 3rd available appt.Input Capacity: Number of patients served
– Continuity and Access– Measurement of productivity (templated hours
vs. actual hours)
Process AnalysisProcess Analysis
Developing a team to match the work of the practice– Flowchart of clinical work– Clinical staff activity sheets– Staff questionnaires and interviews– Patient time study – Front desk phone log
Space AnalysisSpace Analysis
Identify the number and type of rooms Identify specialized equipment necessary for
practiceDetermine clinic utilization rate
(Avg. # of pts. seen / day) x (Avg. exam time per pt)Utilization rate = ------------------------------------------------------------------------------- x 100
( # of exam rooms ) x ( tot. time clinic sees pts [hrs/day] )
Revisiting Clinical RedesignRevisiting Clinical Redesign
Interpersonal
Procedures
Roles
Structure
Goals/Mission
InterpersonalInterpersonal
Strengths– Opportunity to use initiative and keep pace with job– Satisfaction of working at clinic
Weaknesses– Cooperation, communication, attitude, and morale
rated fair to poor by 60% of the respondents– High turnover rate of front desk staff
Staff Satisfaction SurveyStaff Satisfaction SurveyN = 5N = 5
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%Job Pace
Use Initiative
Job Security
Performance
Team Cooperation
Attidues/ Morale
Team Runs Smoothly
Team Stress
Implement Change
Overall Rating
Recommend Office
Excellent, Strongly agree, Not stressful, Within 24 hours, 9 0r 10 team rating
Good, Agree-unsure, stressful-little stressful, 2-4 weeks, 4-8 team rating
Fair-poor, Disagree-stronly disagree, Very stressful, 1-6 months, 0-3 team rating
ProceduresProcedures
Variation in appointment scheduling– Booking outside EPIC – Inappropriate booking – Irregularity in scheduling– Confusion in assigning patients to resident
or attending Phone traffic Nonfunctional front desk support
system Exam and procedure rooms not fully
utilized Minimal overall patient wait time
Space UtilizationAM PM Total
Avg. Number of Patients Seen/Day: 11.6 13.3 12.4Avg. Length of Visit (min): 23 23 23# of Exam Rooms: 7 7 7Total Time Clinic Sees Patients (min/day): 480 480 480Utilization Rate: 8% 9% 8%
Mon Tue Wed Thu FriAvg. Number of Patients Seen/Day: 14.1 11.4 10.4 12.4 14.2Avg. Length of Visit (min): 23 23 23 23 23# of Exam Rooms: 7 7 7 7 7Total Time Clinic Sees Patients (min/day): 480 480 480 480 480Utilization Rate: 10% 8% 7% 8% 10%
Space AssessmentSpace Assessment
Total of 29 patients Data needs to be correlated with the reason for visit/
type of procedure
Patient Wait Times Oral Surgery
-60
-40
-20
0
20
40
60
80
100
Patients
min
ute
s
Waiting time (App-Entrance)
Waiting time (resident)
Waiting time (physician)
Time spent by doctor or res
Time in clinic
RolesRoles
Need to clarify and match staff roles for appropriate scheduling
Unclear reporting roles Exclusion of appropriate people when
decisions are madeSignificant backlog insufficient capacityCurrent secretarial staff is sufficient to
support an additional physician
Demand vs. AvailabilityDemand vs. AvailabilityOral Surgery Demand vs. Availability
Boyd, McKenna, Werther, Oral Surgery Residents 1/00 - 12/00
10003
59175616
4009
0
2000
4000
6000
8000
10000
12000
Booked Appointments Completed Appointments Potential Template (EPIC) Actual Template (EPIC)
Nu
mb
er
of A
pp
oin
tme
nts
Structure
Clinic information systems ineffective for clinic support
Some changes are possible currently while waiting for new systems to be rolled out
Goals/MissionGoals/Mission
Data suggests Oral Surgery Clinic has excellent staff willing to provide excellent care for their patients with or without a good support system
RecommendationsRecommendations
Hire an additional doctorEstablish standard front desk procedureAutomatic phone routing systemEliminate personal calendar appointmentsSet-up procedure daysUse procedure rooms for procedure onlyClarify staff roles
AcknowledgementsAcknowledgements
Dr. Paul KingDr. Doris QuinnCenter for Clinical ImprovementOral Surgery Clinical StaffUmang Dosi