Increasing Clinical Efficiencies through the Use of an Electronic Content Manager

State: FL Type: Promising Practice Year: 2015

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The goals of implementing a patient friendly Electronic Content Manager (ECM) queuing system was to track and monitor customer flow in order to allow for real time patient flow analysis so adjustments could be made as necessary to meet the needs of clients and increase throughput. The implementation of a queuing system would allow for staff accountability based on analysis of direct service times, programmatic cycle time, and improve organization of the physical plant flow. In making these changes, customer service wait times would decrease and increase access/opportunities to services utilizing existing resources. 

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Broward County Health Department
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Increasing Clinical Efficiencies through the Use of an Electronic Content Manager
Broward County is located in the southeastern portion of the state of Florida with Miami-Dade County to the south and Palm Beach County to the north.  Broward County’s 2013 population estimate of 1,838,844, represents 9% of the State’s population, and is the second most populous county of the 67 counties in the State of Florida and eighteenth most populous county in the United States (US Census).  Its diverse population includes residents representing more than 200 different countries and speaking more than 130 different languages.  31.4% of the residents are foreign-born.   Broward County is a minority/majority county demonstrated by its 2013 population by race (Black 28.5%, Asian 3.6%, Hispanic 26.9%, other races 4.1%, more than one race .2%, for a total of 59.5% and White 40.8%). The Florida Department of Health in Broward County (DOH-Broward) is the official Public Health Agency in Broward County and has been operational since 1936. It is part of the Integrated Florida Department of Health (DOH) and operates in cooperation with the Broward County Commission under Florida Statute 154. DOH-Broward’s mission is “to protect, promote and improve the health of all people in Florida through integrated state, county and community efforts”.  DOH-Broward is the lead agency providing core public health functions and essential services in the county as part of a complex public health system that includes hospitals, clinics, planning agencies, community-based organizations and others.  DOH-Broward provides population/community-based services to the county’s 1.8 million residents and over 10 million annual visitors, and is responsible for assessing, maintaining and improving health and safety within the county.   Lack of a real time means for tracking clinic flow led to lengthy wait times for services which reduced the number of clients served and capacity of public health services offered. The number one cause of client dissatisfaction was wait times as evidenced by customer survey responses. In implementing a real time queuing system, DOH-Broward would be able to address and improve wait times by tracking services in real time.  By improving efficiencies in the clinics, staff morale and turnover has improved. The goals of implementing a patient friendly Electronic Content Manager (ECM) queuing system was to track and monitor customer flow in order to allow for real time patient flow analysis so adjustments could be made as necessary to meet the needs of clients and increase throughput. The implementation of a queuing system would allow for staff accountability based on analysis of direct service times, programmatic cycle time, and improve organization of the physical plant flow. In making these changes, customer service wait times would decrease and increase access/opportunities to services utilizing existing resources.  Practice implementation/activities:• Researched means of decreasing service times while still maintaining quality of services offered in meeting public health objectives• Conducted manual patient flow analysis of a sexually transmitted disease (STD) clinic over 3 days • Researched electronic patient flow analysis software systems that would allow for real time patient flow analysis and analysis of historical data to determine scheduling patterns, staff productivity, and staffing patterns.• Initial piloted at one service site of ECM – Paul Hughes Health Center• Conducted staff training and gathered input from hands on users to determine best use of system• Based on successes of pilot program, expanded to all other DOH-Broward other sites & programs • Compared Manual Patient Flow Analysis to new ECM Clients take a “ticket” from a self-service kiosk which initiates the start of the cycle time begins and have seat until called. Public health educational videos are shown on the queuing system monitors. Through queuing software system, reception desk calls by client by assigned numbering system over audio system from all areas of the health center in client’s language of choice which improved confidentiality as no names are called. Front desk able work with one client at time privately, without others standing closely. All staff and supervisors able to view the status of all clients at each service point. Staff work evenly distributed due to accountability factors through reporting features. Able review the reports and identify how many and how long each provider is taking with a client. Supervisors are able to monitor clinic flow through any internet connection. In implementing of Q-Flow, programmatic cycle times have improved by 50% since 2013 through the efficient movement of patients through the system and better utilization of existing resources. As a result, all goals and objectives were met. Factors that led to the success of the practice included senior leadership’s full support of the need to implement an automated queuing system. Staff’s input and buy in also contributed to the ongoing success.
As a result of long wait times for Public Health services, clients were not completing services resulting in missed opportunities to meet the DOH-Broward mission “to protect, promote & improve the health of all people in Florida through integrated state, county, & community efforts”. All clients receiving services at a DOH-Broward facility as affected by this practice change. In 2013, 106,000 clients were seen in DOH-Broward facilities. Percentage of the population reached was 100%Previously, manual routing slips were utilized to track clients receiving services but data collection procedures were fragmented and inaccurate. Routing slips were misplaced because a control system was not in place, resulting in increased service and wait times. As a result, customer service survey responses were unfavorable and staff morale was adversely affected.The DOH-Broward Health Center Administrators were tasked with improving cycle times in the health centers. They researched queuing systems to better track client flow through the clinics. Queuing theory involves arrivals at a facility and service requirements of that facility (i.e., technicians, pharmacists, nurses). The number of arrivals generally fluctuates over the course of the hours that the facility is available for business. Queuing management consists of three major components:1. How customers arrive 2. How customers are serviced 3. The condition of the customer exiting the system Arrivals are divided into two types:1. Constant – exactly the same time period between successive arrivals (i.e., machine controlled). 2. Variable – random arrival distributions, which is a much more common form of arrival (i.e. clients who walk in for services without an appointment). In implementing a real time queuing system, DOH-Broward would be able to address and improve wait times by tracking services in real time.  By improving efficiencies in the clinics, staff morale and turnover has improved. The goals of implementing a patient friendly Electronic Content Manager (ECM) queuing system was to track and monitor customer flow in order to allow for real time patient flow analysis so adjustments could be made as necessary to meet the needs of clients and increase throughput. The implementation of a queuing system would allow for staff accountability based on analysis of direct service times, programmatic cycle time, and improve organization of the physical plant flow. In making these changes, customer service wait times would decrease and increase access/opportunities to services utilizing existing resources. Practice implementation occurred from 07/2012 (pilot)-09/2014:• Researched means of decreasing service times while still maintaining quality of services offered in meeting public health objectives• April 2012 conducted manual patient flow analysis of sexually transmitted disease clinic over 3 days • May 2012 Researched electronic patient flow analysis software systems that would allow for real time patient flow analysis and analysis of historical data to determine scheduling patterns, staff productivity, and staffing patterns.• ACF Technologies Q-Flow software was chosen due to its flexibility in tailoring the queuing system to a healthcare environment, real time data views, and friendly reporting functions.• July 2012 Initial piloted at one service site – Paul Hughes Health Center• Conducted staff training and gathered input from hands on users to determine best use of system• January 2013: based on successes of pilot program, expanded to all other DOH-Broward other sites & programs with implementation at new service site occurring September 2014 • Compared Manual Patient Flow Analysis to new, automated system The implementation of constant queuing software:• Allows customers to relax in a lobby environment instead of standing in line. • Supervisors are able to improve efficiency by matching skillsets with customer needs. • Managers gain transparency of operations through real time visibility into customer service metrics. • Greater organization of clinic flow resulting in efficiencies for supervisors, staff, and clients.• Clients are assigned a generic number that correlates with a DOH-Broward service improving client confidentiality.• Clients are able to view where they are in the queue from the surrounding TV monitors so they are aware of current wait and service times. • TV monitors show educational videos and important public service announcements to meet public health objectives.• Ticket numbers are called in the language that the client chooses at the self-service kiosk which ensures cultural competence. The constant queuing system gives managers the ability to view the status of clinic flow from any location. Not only can decisions be made to move staff within the public health center but also move staff from other DOH-Broward sites to ensure clients are be served where the need is greatest.  For example, if one center has more clients waiting in Q-flow than the other site, a decision is made to move staff to location where the need is greatest. Previously, clients were offered the option of going to other sites with lower wait times. Staff is now able to view where clients are in the Q-Flow queuing system in real time and make decisions regarding how to manage the workload to best meet client needs. Supervisors were able to review Q-Flow data to evaluate clinical flow, staff productivity, and scheduling patterns. Schedules would be adjusted based on available resources and client needs. Productivity standards were set for the staff based on analysis of Q-Flow reports. Complete service times were reduced by 50% overall since system implementation in 07/2012 (pilot)-09/2014. The AIDS Drug Assistance Program experienced the greatest reduction in service times with an overall decrease of 75%in service times. Vital Statistics, Family Planning, and Immunization service times decreased by 50%. Since implementation of Q-Flow, overall customer satisfaction has increased from 87% in September 2013 to 95% as of September 2014.  
Global Immunization|Teen Pregnancy
The number one cause of client dissatisfaction was wait times as evidenced by customer survey responses. In implementing a real time queuing system, DOH-Broward would be able to address and improve wait times by tracking services in real time.  By improving efficiencies in the clinics, staff morale and turnover has improved. The goals of implementing a patient friendly Electronic Content Manager (ECM) queuing system was to track and monitor customer flow in order to allow for real time patient flow analysis so adjustments could be made as necessary to meet the needs of clients and increase throughput. The implementation of a queuing system would allow for staff accountability based on analysis of direct service times, programmatic cycle time, and improve organization of the physical plant flow. In making these changes, customer service wait times would decrease and increase access/opportunities to services utilizing existing resources.  The project time period was 07/2012 (pilot)-09/2014. At community meetings, stakeholders provided input on ways to improve clinical services that included exploring ways to improve clinic cycle time.  Random clients were surveyed by site supervisors on overall satisfaction with services received.  Wait times was consistently a cause of concern.  Another concern identified was clients who stepped out to make a phone call and would lose their place in line.  Health department staff morale was affected as clients frequently complained about wait times.  Clinic staff provided input and guidance in designing the Q-flow system layout. The queuing audio system would broadcast throughout the service site which allowed for more mobility for the clients. Startup costs were $8,000 per queuing system/per site X 10 sites.  This included the hardware, software, audio system, paper ticket printers, self-service kiosks, onsite training, and one year of support.
The number one cause of client dissatisfaction was wait times as evidenced by customer survey responses. In implementing a real time queuing system, DOH-Broward would be able to address and improve wait times by tracking services in real time.  By improving efficiencies in the clinics, staff morale and turnover has improved. Staff has reported greater job satisfaction in that work loads are more evenly distributed as a result of the automated queuing system, establishing productivity standards, and supervisor’s analysis of staff productivity. The implementation of a queuing system allowed for greater staff accountability based on analysis of direct service times, programmatic cycle time, and reorganization of the physical plant flow. In making these changes, customer service wait times decreased and access/opportunities to services utilizing existing resources increased.  Currently, clients may be transferred in the Q-Flow system for other services in a center while utilizing the same queuing number so they do not lose their place in line which eliminates the need to restart the wait time process as the system figures in the time already in the system when the ticket number is moved to another service.  Future plans include expanding the transfer option to other service sites throughout Broward County. Example: a client receives services in Pompano Beach and needs to complete services at the Fort Lauderdale location.  The queuing system will transfer the client’s assigned number to the new service site.
Lessons learned is that in order to keep clients engaged in completing services at DOH-Broward, a systematic tool was needed for data collection. From the ECM queuing system, supervisors could constantly evaluate data so staffing patterns, schedules, and resources reflect true demand at service sites.  In doing so, wait times decreased, capacity increased, and staff morale improved. Due to the successes of implementation of the queuing system, it has been implemented agency wide.  Senior leadership is fully supporting the continued use of Q-Flow and any upgrades for future use.
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