Sheffield Contraception and Sexual Health Service

Microsystems Approach toImproving the Drop-In Clinic

Our ServiceProvide accessible, equitable and targeted

Contraception and Sexual Health services for the residents of Sheffield

Open access from 8.30am - 3.30pmYouth Clinic 3.30 – 6.00pmAppointment clinics running alongsideIn city centre – ease of accessPopular service – 100+ patients per day

In the beginning…Staff stressed, working overtimePressure on Reception Waiting room full to burstingWaiting time anything from 10m to 2hrsUnable to tell patients how long they would

be waiting.Capacity uncontrolled – closing early when

too many on list so patients being turned away

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Arrival Vs Wait Time: CHC Drop-In, September 2012

Team ApproachStarted in April 2013Multidisciplinary Team – invitation to all staff

to express an interestBegan with Ground Rules and the 5 PsLots of number crunching and measuring

what we already thought we knew

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Drop-In Attendances

am - Seen am - Walked Out pm - Seen pm - Walked Out

MildredMildred is 21 years

oldShe lives in S5 She is in a new

relationshipMildred has

attended Drop In clinic for contraception advice

What does Mildred want from us?

What does Mildred need?

Our AimsTO IMPROVE THE DROP-IN CLINIC WITHIN SCaSH

THE PROCESS BEGINS WITH: Patient arrives at clinic

THE PROCESS ENDS WITH: When the care is complete

BY WORKING ON THE PROCESS WE EXPECT: Reduced waiting times Staff finish on time Not turning patients away To give each patient the time they need

IT IS IMPORTANT TO WORK ON THIS NOW BECAUSE: We need to improve the service to meet the changing demand

of our patients

Idea: Allocate Patients a Time SlotHow long should the slot be?What happens if you run over?What happens if you run out of slots?What about emergency contraception?How do you get a second opinion?

Patient SurveyWe are considering ways in which we can change the Drop-In Clinic for the better and would be grateful for your opinion on the following.

Would you prefer: an appointment on the same day, or to wait in a Drop-In clinic.

First TrialOne morning only – capacity control using

slots30-minute appointmentsPatients could choose to go away and come

back at their appointment time or sit and wait

It didn’t work!Didn’t have enough appointment slotsPatients were asked to come back to pm DI,

which increased demand and staff stress levelsSome slots weren’t long enoughSome were too longReception staff constantly asking what to do

with different patient requests

Perseverance20 minute slotsSome appointments were double-lengthBlocked one slot at the end for emergenciesSeparate list for ImplantsIntroduced a “supporting clinician” roleSlowly increased duration of the trial until

the system was adopted and we were “tweaking”

The Experience“Sometimes Frustrating”

Trying to get a consensusPace of change very slow – need patience and

trust in the system“Sense of having achieved something”“Very happy when things work, very anxious

when it doesn’t”Team members’ responsibility on clinic floor –

“YOUR Microsystem” – need to stay true to the cause.

“Take the rough with the smooth”

Experience“The meeting is a safe place to air your

frustrations and negativity. There’s always someone to make you feel better.”

Excellent to reflect on how far we’ve come and what it was like before.

Doctor: “I’ve been off for 6 weeks and can’t believe what a great difference it’s made”

“Where are all the patients?”“Makes you feel proud”

Success!!Final Model:Rebranded “Walk In Appointment Clinic”Supporting Clinician role clarifiedPositive Feedback from staff and patientsWorst week = 45 turned away; Last week

= none!Staff finish on timeMuch calmerFeeling of being in control of your working

day and pace of working

Challenges AheadFrom Jan 2014Integrated Sexual Health service: SCaSH and

GUMManaging patients across 2 sitesWorking with different skill sets across 2

specialitiesOffering holistic sexual health service