Clinical Productivity Dashboard

State: FL Type: Model Practice Year: 2013

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The Volusia County Health Department is a governmental subdivision of the Florida Department of Health, one of the 67 county partnerships between the State and County governments to provide health services to the people of Florida. Volusia County, Florida has an approximate population of 494,593 residents. Volusia County Health Department (VCHD) serves as the safety net for residents who do not have a medical home and as a leader in the community for public health issues. Volusia County Health Department's Clinic consists of four clinical sites; two Dental offices located though out our county and conduct outreach within our community.

 

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Volusia County Department of Health
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Clinical Productivity Dashboard
The Volusia County Health Department is a governmental subdivision of the Florida Department of Health, one of the 67 county partnerships between the State and County governments to provide health services to the people of Florida. Volusia County, Florida has an approximate population of 494,593 residents. Volusia County Health Department (VCHD) serves as the safety net for residents who do not have a medical home and as a leader in the community for public health issues. Volusia County Health Department's Clinic consists of four clinical sites; two Dental offices located though out our county and conduct outreach within our community. Historically, accessing clinical productivity reports across operational sites was tedious, inconsistent and unreliable. This proved to be true for Volusia County Health Department. In July 2011, this team meet in an effort to improve our reports and analyze our data of our clinical services. The development of an effective system to be put in place to measure productivity, a multi-disciplinary team meets to build a consensus around our core functions and identify the most valid and reliable measures to report and monitor productivity. This team is comprised of Senior Leaders, Clinical Managers, Clerical Supervisors, Finance and Accounting, Health System Administrator and Information Technology. Our goal is to assess our clinic productivity and identify opportunities for improvement allowing us to work more efficiently and effectively while providing services to our community. The team analyses, stratifies operational processes within the clinics, and applies these processes to a clinic productivity model. Uniform processes continue to be developed and agreed upon by the team. Key clinical indicators are identified as measurements for productivity. Data and reporting needs are developed for monitoring these indicators. Our methodology is to develop and organize these reports into a systematic, user friendly, accessible tool for decision making. This process is accomplished by utilizing existing software to build reporting menus and a free-ware product to view Crystal Reports. We continue to develop reporting menus and reports for the dashboard to maximize our evaluation processes. We continue to use the Plan-Do-Check-Act (PDCA) mechanism for process management on the dashboard – allowing us customize reports needed to monitor and manage our daily operations. As a result, we developed a web-based clinic dashboard, which includes key productivity and operational indicators. This dashboard allows managers and employees to access consist, reliable, meaningful information resulting in “managing by fact.”
Responsiveness The public health issue that this practice addressesVolusia County Health Department (VCHD) serves as the safety net for residents who do not have a medical home and as a leader in the community for public health issues. Volusia County Health Department's Clinic consists of four clinical sites; two Dental offices located though out our county and conduct outreach within our community for public health issues. Volusia County Health Department (VCHD) did not have a mechanism to evaluate efficiencies and effectiveness of clinical operations in all sites. This resulted in inconsistencies in operational functions, delivery of services, and an effective use of resources within VCHD. Process used to determine the relevancy of the public health issue to the communityAs VCHD serves as a safety net for health in our community, it is vital to ensure a consistent level of quality of service delivery throughout VCHD. This necessitated a hard look at clinical operations to determine what our core functions were and our most valid and reliable measures to report and monitor these functions. Valid and reliable information is needed to facilitate the strategic plan process, allowing the most effective and efficient use of our resources to meet community needs. Over the past five years, the Volusia County Health Department (VCHD) has seen a consistent and significant increase in clients seeking services. At the same time Florida, county health departments have experienced several reductions in funding. The VCHD experienced a ten percent reduction in state and federal funding this year. How the practice addresses the issueA multi-disciplinary team continues to meet. The team evaluates the operational process flows within the clinics and identifies key indicators that represented productivity measures. During the process flow analysis, opportunities for improvement creating standardized procedures, data collection and tools available to staff were identified and implemented. This team continues to evaluate the feasibility of utilization of existing data, reporting tools and delivery mechanisms. The presentation of data was decided to be in a reporting dashboard format including two areas of focus Clinical Productivity Management Tool and the Nurse Management Tool. Much of the data existed in our computerized Health Management System, however; accessing reports was difficult, time consuming, unorganized and not user-friendly. Based on this, the team explored various options to create a repository of user-friendly reports. The team organized the various reports utilizing the existing SQL server, current copies of Crystal Reports to develop the reports, existing software to build reporting menus and a free-ware product to view Crystal Reports. The IT programmer and the Health System Administrator developed the reporting menus and reports for the dashboard, the rest of the team ran and evaluated the reports, providing feedback. We continue to use the Plan-Do-Check-Act (PDCA) mechanism for process management on the dashboard allowing us customize reports needed to monitor and manage our daily operations. Because of our team efforts, a web-based dashboard was developed that included both focused areas and was readily accessible, user friendly, timely, and organized. We have continued our analysis and development processes. These measurable tools are used to improve accountability and make data driven decisions based on budgetary and operational restraints.   Innovation Evidence based strategies used in developing this practiceThis innovated process ensures the information needed to make data driven decisions. We serve as a safety net for health in our community, it is vital to ensure a consistent level of quality of service delivery. This necessitated a hard look at clinical operations to determine what our core functions were and our most valid and reliable measures to report and monitor these functions. Valid and reliable information is needed to facilitate the strategic plan process. This achievement allows County Health Departments to better manage and target its limited resources to services most needed by our local community. Some of the decisions resulting from the development and utilization of these reports are: 1) To assign providers, nurses and support staff to different clinics based on the number services provided and the enhancement of the client schedules to “same day next day” appointments. 2) To develop best practices by comparing the services and the productivity at the same provider level in order to streamline procedures and enhance efficiency. Senior leadership felt that this was a valuable tool to assist in the allocation of resources. 3) The decision to provide full service clinics five days a week at two of the four “high” volume clinics offering clients all of the services that we provide daily. The two outlying clinics would only offer “full client services three days. In making this change, VCHD was able to maximize its resources and reallocate staff to the ‘high” volume clinics. These resulted in having these two outlying clinics to have three days of full client schedules and staff was not sitting in clinics with empty waiting rooms. My reassigning staff to the “high” volume clinics the client appointment schedules was able to be overbooked. The result of this was increased revenue at the two busier clinics since providers and support staff was available to provide services. It also prevented work force reduction and the need to hire additional staff at the “high” volume clinics This practice is a creative use of an existing tool or practice How the practice differs from other approaches used to address the public health issueAt this time, the majority of the County Health Departments are using reports developed at the agency level. Although these reports are useful, they do not allow timely response and tend not to meet specific data analysis and requirements for local counties and communities. Showcasing our process to other County Health Departments has resulted in VCHD developing Clinic Productivity Dashboards for several other County Health Departments in Florida. VCHD has several contracts with other CHD’s to develop and train staff on the utilization of these reports. The advantage to the dashboard reports is that once created, the functionality loaded on their computers anyone authorized to generate them can do so quickly, and management decisions can be made Process used to determine the practice is a creative use of an existing tool or practiceImplementing this dashboard has eliminated the need for personnel to meet, decide on what kind of information is needed, and then wait for Information Technology to create and deliver a custom report. The report distribution mechanism is a locally developed application that is saving hours of staff time. There was no cost incurred with purchasing new software or hardware. This product creates a real time report within seconds instead of hours. This tool was needed to manage daily operations and make informed decisions. This innovative product establishes best practice productivity management that was not feasible across the organization previously. Tool used in a creative wayThe Quality Improvement Toolkit was use for our processes. In an effort to standardize clinical decision-making, we evaluated existing processes, identified key clinical data for measurement. The team stratified organizational reporting needs to make data driven decisions and for strategic planning. Enhance the productivity of the clinics to maximize current resources. This practice differs from other approaches used to address this issuedeveloped at the agency level. Although these reports are useful, they do not allow timely response and tend not to meet specific data analysis and requirements for local counties and communities. Showcasing our process to other County Health Departments has resulted in VCHD developing Clinic Productivity Dashboards for several other County Health Departments in Florida. VCHD has several contracts with other CHD’s to develop and train staff on the utilization of these reports. The advantage to the dashboard reports is that once created, the functionality loaded on their computers anyone authorized to generate them can do so quickly, and management decisions can be made.
Primary stakeholdersVolusia County Health Department and our community LHD's roleVCHD's role as an innovative leader in the development of the dashboard remains an effort to improve the management of our local resources and improve efficiency. We strive for continuity of the Productivity Dashboard and acceptance as a Best Practice for all County Health Departments. As we continue to grow our knowledge of measures and their relationships to clinical operations, we are able to develop more precise and targeted reports. Our Senior Leadership staff remains impressed with the outcome of our project it is simple and easy to use. Based on this, we have showcased our dashboard to other County Health Departments, at coalition meetings, business meetings and manager meetings. Stakeholders/partners The approach of utilizing a web-based dashboard to measure productivity is applicable to all County Health Departments. This process has been showcased at a regional CHD Business Managers meeting. It was so positively received this group requested it be presented to the Regional Administrative Leadership Meeting. The dashboard was well received by this group also. Requests for additional presentations for various CHD groups are scheduled. Based on feedback from these presentations, work is being done to enhance and expand the dashboard so that other CHDs can utilize this tool as well. Although VCHD initially developed the dashboard, other County Health Departments are very enthusiastic about the project. Based on this, a network of reporting experts has been identified to assist with creating and expanding the dashboard to meet not only local Health Department needs but possible regional reporting needs and requests as well. Additionally, a regional steering committee is under consideration to assist with the direction of reports and development. VCHD saved approximately $25,000.00 in equipment and software by developing our own process for the dashboard. Three other County Health Departments have currently acquired this process from us. Additional counties have expressed interested in the process after it was showcased as a best practice to our consortium. They have not had to purchase Crystal Reports Servers, Crystal Reports Software or pay to train employees. The money saved each local County Health Department is approximately $18,000.00. Lessons learned County Health Department was not accustomed to operating like a business. Indicators and measures were not readily available. Clinical staff was not in tune with how to measure procedures and accountability for clinical services. Additionally, budget constraints have added to the overall difficulty of understanding the need to maximize resources.   Specific tasks takenA. Review and document clinic process flows B. Establish key clinical indicators based process flows C. Create reports based on key clinical indicator D. Develop new web based process for accessing and categorizing reports E. Key staff continues to evaluate the reassignment of staff. F. Evaluate processes create action plans for improvement. Time frameReview and document clinic process flow took approximately six months. Establish key clinical indicators based process flows two months. Create reports based on key clinical indicator on-going process. Develop new web based process for accessing and categorizing reports one month. Key staff continues to evaluate the reassignment of staff on-going process. Evaluate process; create action plans for improvement however, it remains an on-going process and VCHD continues to create new reports based on additional indicators, as the requests for data driven decisions are needed. Also has additional CHD’s request the Dashboard reporting system new reports for these counties may need to be enhanced or developed. Outline of basic steps Historically, accessing clinical productivity across operational sites was tedious, inconsistent and unreliable. This proved to be true for Volusia County Health Department. In an effort to improve our reports and analyze our data of our clinical services. The development of an effective system to be put in place to measure productivity, a multi-disciplinary team meets to build a consensus around our core functions and identify the most valid and reliable measures to report and monitor productivity. This team is comprised of Senior Leaders, Clinical Managers, Clerical Supervisors, Finance and Accounting, Health System Administrator and Information Technology. Our goal is to assess our clinic productivity and identify opportunities for improvement allowing us to work more efficiently and effectively while providing services to our community. The team analyses, stratifies operational processes within the clinics, and applies these processes to a clinic productivity model. Uniform processes continue to be developed and agreed upon by the team. Key clinical indicators are identified as measurements for productivity. Data and reporting needs are developed for monitoring these indicators. Our methodology is to develop and organize these reports into a systematic, user friendly, accessible tool for decision-making Lessons learned This Practice was submitted in 2011 and was recognized with a NACCHO Certificate of Promising Practice however it was in the beginning stages of development. We did not have our outcomes clearly identified and were in the early stages of reviewing and analyzing the needs of our clinics. With this submission we can see the importance of these reports and can easily identify the improve efficiencies within our organization. We have been able to make decisions based on real time data and management has a proactive stage to keep VCHD from having to impose workforce reduction. Many other CHD’S throughout the state have not been able to sustain their workforce. VCHD remains optimistic that with continued analyses’ of our clinic productivity and reallocating resources accordingly with can remain a positive presence in our internal and external clients. Cost of implementationA sub group developed reports to display pertinent information for each indicator. When difficulties arose when installing the Crystal Reports Server software, the sub group used ingenuity and creativity identifying free-ware software and the Crystal Reports application to design and implement a user friendly, web-based dashboard containing the key productivity measures and operational indicators. This development resulted in a simple and inexpensive mechanism to provide pertinent information on-demand without the need to rely on others. We saved approximately $25,000.00 in equipment and software by developing our own process for the dashboard. Three other County Health Departments have currently acquired this process from us. Additional counties have expressed interested in the process after it was showcased as a best practice to our consortium. They have not had to purchase Crystal Reports Servers, Crystal Reports Software or pay to train employees. The money saved each local County Health Department is approximately $18,000.00
Objective 1: Analyze operational processes the clinics for improvement and consistency. We organized a multi-disciplinary functional team to build a consensus around our core functions. This team consists of all Clinic Managers, Clerical Supervisors, Finance and Accounting, Data Processing Administrator and an IT Programmer. The team facilitator was one of our Clinic Managers. We meet weekly to establish and define clinic profiles, which play a valuable role in our clinical operations. We created templates outlining existing data, available reporting mechanisms and key indicators to measure. Samples of reports from our statewide Health Management System were generated and analyzed for effectiveness.Areas of improvement were identified based on the analysis by the team and Senior Management. New improved or modified reports were developed. Our Health Management System clinical service data is collected and analyzed. During this evaluation process, trends have been identified and all providers reallocate resources to increase efficiency at all clinics. The reallocation of providers, nurses and other staff members has allowed us to maximize services provided to our clients. Objective 2:Identify key clinical indicators for measuring productivity. During the weekly meetings of the Clinic Management Team, we strategize productivity factors for our core clinical functions. The team developed reports and data collection from our statewide Health Management System. We developed a consensus that identified indicators to monitor the outcomes of our clinical operations. The team identified two major areas one for Nurse Management and one for Senior Management. The development these reports have allowed us to measure provider productivity to ensure alignment with VCHD's strategic and budgetary plans. Objective 3:Improve methods for measuring productivity of our clinics. The team meets weekly to address issues related to measuring clinic productivity. The outcome is the continued development of enhanced, targeted reports to monitor our core functions depicting the overall viability of the clinic as well as productivity within the clinic. The monitoring of clinic productivity reports from our Health Management System data is evaluated and adopted as our standardized indicators for our county clinical operations. These indicators have improved the continuity standardization at all clinic sites. This standardization has allowed us to use staff more effectively as all staff follow the same procedures at all sites. The consensus is the reports will be generated and analyzed at least monthly and any variances will be documented. Corrective action and improvement plans are developed and initiated because of these reports. Management by Fact is now a reality!
Stakeholder CommitmentVCHD created a system that maximizes time and effectively produces key indicator reports. The Reporting Dashboard processes results in improve decision making with our agencies core values and services. These clinic productivity reports have played a major role in our strategic planning and budgeting processes by providing key measures and indicators. These measures assist us to utilize our limited resources to effectively serve the health needs of our community. SustainabilityThis tool provides a uniform method to make management decisions within any Health Department. We have readily adapted and implemented this process in four other County Health Departments that are currently using dashboard features. Utilizing free-ware software there is no need to buy equipment or software, in order to create real time reports. We have showcased this process as a best practice to other County Health Departments. The low cost implementation has made this product a sought after tool by other County Health Departments.
 
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