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