Patient Flow Analysis: A Comprehensive Approach to Training of Title X Staff in Virginia

Phoenix, AZ September 20, 2006 Presented by: Anne Elam, RN, MPH, VA Department of Health Shelley Miller, MS, TRAINING 3, Family Planning Council, Philadelphia, PA

Brief History

VA Dept. of Health had used PFA (DOS) in the past, early 1990s, with success

Patient Flow Analysis focuses on clinic efficiency and improvement Time to re-evaluate clinical settings supported by site visit by OPA

Issues we hoped to Explore:

Clinic Waiting Time Utilization of Staff Flow of Services

Secondary By-product:
Greater Staff Satisfaction Decrease Patient Frustration

How We Got Started .

Staff from Title X sites were selected by VA Dept of Health to participate in the trainings Teams (pairs) were selected representing each region/county from throughout VA (managers/technical skills) Each training consisted of: Two 2 day trainings which were delivered to all selected providers. A total of 5 TOP trainings were delivered to a total of 66 providers from March 2005 August 2006 By the end of August 2006, 33 teams of Title X providers from throughout VA were trained and conducting PFA studies with staff

Overview of the Process

At the request of VA Department of Health, Title X grantee, TRAINING 3 contracted with PFA consultant, Brian Senecal, to develop comprehensive plan to train providers throughout VA on the utilization of Win PFA

TRAINING 3 completed one on-site comprehensive WinPFA with the Petersburg health center in VA Feb/March 2005
The materials from this study were used throughout the trainings that followed The first Training of Providers (TOP!) was delivered: Part 1 - March/Part 2 - April 2005

Train the Providers Part 1

The first 2-day training was held in a computer lab (local community colleges provided low cost and quality facilities)

Train the Providers Part 1

Design of the training included:

Hands on skills

History of PFA and Why do PFA Purpose of PFA: What it Does & Does Not Do PFA Output: Review of reports of graphs Overview of the PFA process

Review & development of forms Data collection Visual edits Data entry Producing Reports & Graphs Preparing for the orientation and study Conducting the study

What PFA Does Do

Identifies show rate Client time in the clinic and with staff Waiting time between stops (bottlenecks) Lost clients Staff time available and service time Time clients spend at each stop Personnel costs Visit types

What PFA Does Not Do

Determine solutions What staff and clients were doing during contact time If personnel costs are reasonable If waiting time was reasonable The quality of services provided The quality of staff performance

Review of PFA Forms

Codes and Labels Staff Worksheet Clinic Register Staff Register Staff Non-contact and Unavailable time Client Register Client Non-contact and Unavailable time Client Sign-in Sheet

Modified Client Register

Patient Flow Analysis for Windows
Data Set Name ___________________________________________________ Client ID# Reason For Visit Subclassification Client Register

Time of Appointment Time of Arrival # Staff ID 1 2 3 4 5 6 7 8 Reason Unavailable Task Start __ __ : __ __ __ M __ __ : __ __ __ M __ __ : __ __ __ M __ __ : __ __ __ M __ __ : __ __ __ M __ __ : __ __ __ M __ __ : __ __ __ M __ __ : __ __ __ M Start __ __ : __ __ __ M __ __ : __ __ __ M Non-Contact Task Start __ __ : __ __ __ M __ __ : __ __ __ M

__ __ : __ __ __ M __ __ : __ __ __ M End __ __ : __ __ __ M __ __ : __ __ __ M __ __ : __ __ __ M __ __ : __ __ __ M __ __ : __ __ __ M __ __ : __ __ __ M __ __ : __ __ __ M __ __ : __ __ __ M End __ __ : __ __ __ M __ __ : __ __ __ M End __ __ : __ __ __ M __ __ : __ __ __ M

Computer Skills
Accessing WinPFA Data entry Editing/correcting errors Printing reports Printing graphs

Planning the Study

Each pair was expected to complete a PFA study, including:

Developing forms Orienting Staff Completing a study Enter data and print reports and graphs Bring copies of materials to Part 2

Important Reminders
Study coordinators will set the tone for staff attitudes about PFA PFA is not a monitoring tool Keep it simple! There are resources available for any questions

Training of Providers: Part 2

Part 2 took place 4-5 weeks after the first training Participants brought with them copies of their reports and graphs

Part 2

How to interpret the reports (12) and graph Developing an Action Plan Working with staff Practice sessions

WinPFA Summary Report Date _____________________________________________________________________________ The data shown below in this report provides an overview of the clinic session documented by your PFA study. These data, as well as the data found in the body of the report, are dependent on your study design and your ability to carry out that design; for study design considerations and data collection procedures, please see the Patient Flow Analysis for Windows(WinPFA) Data Collection Manual; to request a draft copy send an e-mail to pfa@cdc.gov. Introduction Number of Appointments made; 20 Number of Appointments kept; 13 65.00% Number of Staff; 9 Clients Served InSession; 15 Clients Served Not InSession 0 Number of Contacts; 88 Number of NonContacts; 0 Number of UnAvailables; 4 Number of Events; 92 Published Clinic Hours 1:00:00 PM to 5:00:00 PM Earliest Time in the Data Set 12:30:00 PM Latest Time in the Data Set 5:00:00 PM Earliest Time, Client 12:30:00 PM Latest Time, Client 4:51:00 PM Earliest Time Available-To-Serve 12:30:00 PM Latest Time, No-Longer-Available-To-Serve 5:00:00 PM Client-Oriented Data Client Activity Contact Time Non-Contact Time UnAvailable Time Gross Waiting Time Total Time in Clinic Staff-Oriented Data; Average Work Day Duration Per Staff Minutes 83.83 0.00 83.83 % of Total Minutes 100.00% 0.00% 100.00% % of Staff Delivering 100.00% 0.00% Duration (Minutes) 36.10 0.00 0.00 38.03 74.13 % of Total Time in Clinic 48.70% 0.00% 0.00% 51.30% 100%

Service Type Contact Non-Contact Total

Staff-Oriented Data; Service Delivery Duration Activity Total Duration (Minutes) | | | Duration (min) For The Average Staff | Client | % of Total | Workday |

The Graph

Developing an Action Plan

Post selected results for staff to review within several days of study Schedule staff meeting (not more than 1 hours in length) within a week of study Explore what is working well and identify challenges Brainstorm ideas to resolve challenges identified Develop solutions that could work Using reaching consensus technique select 1 3 solutions to implement Assign tasks Develop time line (including when the follow-up study will be performed) Repeat PFA as designed in time line

Observations from site visits

Staff

Cooperation

Changes in Scheduling Practices Changes in Clinic Flow Confirmation and Statistical Data Anecdotal stories

Where Do We Go From Here

Share Best Practices Evaluation of the Project Provide a Review a. Computer Techniques b. Data Analysis c. PFA Graph

Contact Information

Anne Elam
(804) 864-7754, anne.elam@vdh.virginia.gov

Shelley Miller
(215) 985-2645 Shelley@familyplanning.org

CDC: Bill Boyd

770 488-6301 WAB2@CDC.gov www.cdc.gov/reporductivehealth/Prod ucts&Pubs/PFA_support/index.htm