Tollgate Int Med Cycle Time 151120

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Naval Hospital JacksonvilleCAPT Troy Borema, Project ChampionLCDR Eugene Smith Jr MSC USN, Lead Belt/Process OwnerMs. Carola Miner, Command Black BeltMr. Robert Doyle, NME Black Belt MentorInternal Medicine Encounter Cycle TimeCPIMS # DON 0204011

NME-Naval Hospital Jacksonville-FY15: Internal Medicine Encounter Cycle TimeCPIMS # DON 0204012Core TeamProject LeadProject Sponsor / ChampionCommand Black BeltFinancial SMELCDR Eugene Smith Jr. MSC USNCAPT Troy Borema MC USNMs. Carola MinerMs. Wanda Bartley

Team MembersAWO1 Adam Reed USN(GB Co-Lead)AWO1 Eric Leide USN(GB Co-Lead)Ms. Carla Little RN(Int Med Clinic Nurse)Ms. Ann Mott FNP(Int Med Clinic PCM)LT Steven Koplin MC USN(Int Med Clinic PCM)HN Kyle Bowen USN(Int Med Clinic Corpsman)HN James Messersmith USN (Int Med Clinic Corpsman)HN Yolanda Romero USN(Int Med Clinic Corpsman)HN Jacob Moulton USN(Int Med Clinic Corpsman)

Project Charter3Problem Statement:Project Goal:Concern that the current patient demand at Naval Hospital Jacksonville Internal Medicine Clinic may exceed the capacity of Internal Medicine providers was identified during Leadership Rounds in March-April 2015. During FY15, through 31MAR15, the existing processes in the Internal Medicine Clinic have resulted in a three day appointment completion rate of 79%, as well as removal of providers from the appointment schedule to complete encounters and provider job dissatisfaction. Create a streamlined process that reduces patient cycle time and improves the capacity of the Internal Medicine Clinic to meet patient demand

Increase the percentage of Internal Medicine Clinic encounters meeting the Department of Defense Three Day Completion StandardExpected Benefits:MetricBaselineImprovement GoalImprove capacity of Internal Medicine Clinic to meet patient demandIncrease the percentage of internal medicine encounters meeting the DoD Three Day Completion StandardReduction in provider dissatisfaction3 Day Encounter Completion79%Jan-Mar 201595%Mean Patient Flow Cycle TimesSupport Staff-PatientProvider-Patient33 Minutes29 Minutes20 Minutes20 MinutesMean Cycle TimeEncounter Completion3.27 DaysApril 2015Less than 3 DaysTollgatePlanned End DateActual End DatePrimary Metric: Three Day Encounter Completion from monthly DoD DQMC program audit.Pre-Event29MAY1519MAY15Event26JUN1509SEP15Post-Event17JUL1512NOV15Secondary Metrics:Cycle Time: Patient Flow: Patient Check-In to Corpsman Provider TurnoverCycle Time: Patient Flow: Provider Review Patient Info o Proceed to Next PatientCycle Time: Patient Check-In to Encounter signed in AHLTAValidate31JUL1530NOV15

Voice of the CustomerCPIMS # DON 0204014Patients:Patients have to wait past scheduled appointment time when encounter cycle times extend beyond scheduled appointment durations. Support Staff:Unique provider preferences for patient appointments can lead to support staff having to scramble to get patient into rooms Providers:Providers staying late and needing time out of clinic to complete patient encounters negatively impacting access to care for some patients.Command Leadership: During leadership rounds Internal Medicine Clinic providers expressed concern that patient enrollment level may be greater than providers capacity to deliver care. DHA:Internal Medicine Clinic consistently below DoD standard for timely completion of encounters.

Communication PlanCPIMS # DON 0204015 COMMUNICATION PLAN: Internal Medicine Encounter Cycle TimePurpose AudienceMediaDiscussion TopicsResponsible PersonFrequency of CommunicationLocationNotes/StatusMEETING AGENDAProject Team EmailProject statusNext team meeting (date, time, location, etc.)Action item statusOther project infoTeam Leader Q MeetingOutlookCHAMPION MEETINGChampion/GB/BB/ Sponsor/Process OwnerFace-to FaceProject Charter BriefTollgate BriefsProject status Team Leader w Lead Belt Within 2 weeks of completing TollgateVariesTEAM MEETINGProject TeamFace-to FaceCharter, SIPOC, Current State Map, Ishikawa, VOC, VSA & VSM, etcProject LeaderAs needed. Agenda can include problem solving, evaluation, reporting, decision making, or planningVarriesPROBLEM SOLVING MEETINGProject Team and Ad Hoc/SMEs as neededFace to FaceAnalysis of specific issue using appropriate tools. Team Leader w Lead BeltAs needed, may be included in regular team meetingVariesEVALUATION MEETINGProject TeamFace-to FaceProject StatusReview of barriers to implementationTeam LeaderMonthly or as needed, may be included in regular team meetingVariesREPORTING MEETINGSProject TeamEmailTeam progress and updates of outcome or in-process metrics Lead BeltMonthly or as needed. may be included in regular team meetingVariesDECISION MAKING MEETINGSProject Team and Ad Hoc/SMEs as neededFace-to Face Proposed Charter changes and actions on JDIsTeam LeaderAs Needed, may be included in regular team meetingVariesPLANNING MEETINGProject Team and Ad Hoc/SMEs as neededFace-to FacePlan JDI implementationsProject TeamAs Needed, may be included in regular team meetingVaries

Data Collection PlanCPIMS # DON 0204016

Baseline DataCPIMS # DON 0204017MetricBaselineGoalDeltaPrevious Support Staff Cycle Time33 minutes20 minutes13 minutesPrevious Provider Cycle Time29 Minutes20 minutes6 MinutesEncounter Completion Cycle TimePt Check-In to AHLTA Signature3.19 Days20 min

When mean cycle time is > 3 minutesData Quality Manager

IntMed Clinic LPO

IntMed Dept HeadIntMed Dept Head

IntMed Clinic LPO

IntMed Dept HeadIdentify cause of failure and design intervention to correct failure.

Identify cause of failure and design intervention to correct failure.

Identify cause of failure and design intervention to correct failure.Run chart

Run Chart

Run Chart

LSS ScorecardCPIMS # DON 02040118LSS SCORECARDMetric Name:BASELINE RESULTSPOST INTERVENTION RESULTS TOTAL CHANGE FROM BASELINE Patient Flow Cycle Time:(a) Support Staff(b) Provider(a) 33 Min (b) 29 Min14 Min23 Min 19 Min (57.6%) 6 Min (20.7%)Encounter Completion Cycle Time3.19 Days2.52 Days0.67 Days (21.0%)3 Day Encounter Completion:(a) Percent Complete(b) Sigma(a) 79%(b) 2.30(a) 87%(b) 2.63(a) 0.67 Days(b) 0.33 Sigma

NH Jacksonville: Internal Med Cycle Time

What questions do you want to answer?

1.Is IntMed Clinic meeting DoD requirement for timely completion of patient encounters.2. How efficient is the patient flow process in Internal Medicine

MetricData Type (Discrete / Continuous)Operational DefinitionSampling NotesSource and LocationCollection methodWho will collect data

Three Day Encounter CompletionDiscretePer DoD Data Quality Management Control (DQMC) SOP100% SampleMonthly DQMC ReportObtain from NH Jax Data Quality ManagerMs. Wanda Bartley

Cycle Time: Encounter CompletionContinuousTime from Patient Check-In to Provider signs AHLTA Record100% SampleCHCS Ad Hoc BOCISpool and save report as text file. Import into Excel and calculate the difference between Patient Check-In and Provider signature on AHLTA encounter.Health Systems Specialist, Tricare Operations Dept.

Cycle Time for Provider and Support StaffContiniousTime from Patient Check-In to Corpsman Provider Turnover

Time from Provider Review Patient Info o Proceed to Next Patient

Minimum of 5 patient encounters for each of 2 providers Internal Medicine Patient ScheduleTime study checklist AWO1 Adam Reed

How will data be used?How will data be displayed?What is plan for starting data collection?

To assess baseline performance and quantify improvements.Cycle time for Provider and Support Staff: Bar ChartThree Day Encounter Completion: Run ChartCycle Time Encounter Completion: Control ChartObtain baseline data from DQ Manager Ms.Bartley.Create tracking tool for capturing Provider and Support Staff Cycle Times.Create CHCS ad hoc for encounter completion cycle time.