ASA Template Training

ASA Template Training

FY02 ASA Presentation Occupational Medical Service, DS Medical Care in a Timely Fashion Presented by: James Schmitt Team Members: Alpha Bailey James Burger Robert Ostrowski (Team Leader) James Schmitt Office of Research Services, NIH 18 November 2002 1 Table of Contents Introduction . . ASA Template ... Customer Perspective.

Customer Segmentation ... Customer Satisfaction... Internal Business Process Perspective Process Map... Conclusions from Discrete Services Deployment Flowcharts Process Measures Learning and Growth Perspective Conclusions from Turnover, Sick Leave, Awards, EEO/ER/ADR Data Analysis of Readiness Conclusions Financial Perspective Unit Cost.. Asset Utilization.. Conclusions and Recommendations. Conclusions from FY02 ASA.. Recommendations 2 Introduction

3 Occupational Medical Service (OMS) The OMS mission is to provide: Work-related medical care Preplacement medical evaluations Occupational injuries and illnesses Surveillance for health hazards at the worksite Return to work evaluations Care for personal medical emergencies Health promotion activities

4 OMS Quality Improvement (QI) Efforts 1991 - QI training is part of OMS orientation 1992 - Each employee completes a QI project 1992 - Cross-functional QI Teams formed Customer satisfaction surveys Computer application development Review of the preplacement evaluation process Review of clinic hours Review of services available for occupational injuries

1992 - External audit of the OMS QI program 5 OMS QI Efforts (cont.) Customer Satisfaction Surveys prior to the ASA External customer (employee) surveys External customer (supervisor) survey April 1995, November 1995, April 1996, May 1997, April 1999, March 2001 October 1997

Internal customer (OMS) surveys August 1995, June 1996 6 ASA Template 7 ASA Template - 2002 Service Group Provide occupational medical services Discrete Services DS1: Provide occupational medical services Customer Value Proposition Provide work-related, emergent and urgent medical care in a timely manner Service Strategy

X Operational Excellence Customer Intimacy Product Leadership Growth X Sustain Harvest Team Leader Robert Ostrowski Team Members Alpha Bailey, James Burger, Robert Ostrowski, James Schmitt Customer Perspective 8 M aintain S afe W ork ing E nvironm ent - P rovide Oc c upational M edic al S ervic e (OM S )

C u s to m e r P e r s p ec tiv e P e rform a nce Obje ctive P e rform a nce M e a sure In creas e u n d e rs tan d in g o f cu s to mer b as e Cu s to mer s e g me n t atio n o f Dis cre te Serv ic es In creas e cu s to me r s at is factio n Cu s to mer s a tis fact io n ratin g s fro m th e ORS Cu s to me r Sco rec ard fo r e ach Dis c re te Serv ice M e d ica l care in a time ly fa s h io n Time in OM S p rio r to b ein g ev alu ated b y an OM S h e alth ca re p ro v id e r, wit h o r with o u t a n ap p o in tmen t In te r n a l B u s in e s s P ro ce s s P e r s p e c tiv e P e rform a nce Obje ctive

P e rform a nce M e a sure In creas e u n d e rs tan d in g o f p ro ce s s e s . Co mp lete p ro c es s ma p s o f Serv ic e Gro u p /Dis crete Serv ic es Id en tify meth o d s to me as u re Id en tify an d rep o rt o n p ro c es s meas u re s fo r Dis cre te Serv ic es p ro ce s s e s . M e et o r e xce ed g o a ls fo r th e timelin es s o f s e rv ice Pa tie n ts s h o u ld b e s ee n with in 15 min u tes o f th eir s ch e d u le d ap p o in tme n t s . Pat ien ts with u n s ch ed u le d v is it s s h o u ld b e s e en : with in 2 min u t es fo r me d ic al emerg en cy me d ica l care; with in 2 h o u rs fo r u rg en t med ical c are ; an d with in 2 wo rk d a y s fo r ro u tin e med ica l ca re L ea r n in g a n d G r o w th P e r s p e c tiv e P e rform a nce Obje ctive En h an c e q u ality o f wo rk life

fo r emp lo y ees in ORS. M a in tain & en h an ce co mp eten cies fo r th e fu tu re o rg an izatio n . P e rform a nce M e a sure Tu rn o v er Sick Leav e Us ag e Co n ta cts /Co mp lain ts wit h EEO/ER/A DR A ward s /Rec o g n itio n A n a ly s is o f Read in es s In d ex F in a n c ia l P e r s p e ctive P e rform a nce Obje ctive P e rform a nce M e a sure M in imize u n it co s t a t a d efin ed s erv ic e le v el. Ch a n g e in Un it Co s t fo r ea ch Dis cre te Serv ic e

M a ximize u tiliza tio n o f as s ets . A ctu al a s s et s u tilized /p la n n ed as s et u t ilizatio n fo r ea ch Dis cre te Se rv ice 9 Care in a Timely Fashion Our team elected to examine more closely the timeliness of clinical care provided in the OMS Building 10 clinic for: Routine work-related visits (both with and without appointments) Personal medial emergencies

Personal urgent medical problems 10 Customer Perspective Customer Segmentation 11 NIH Injury / Illness Data FY'02 (n = 1345) 12% 23% 2% CC 2% Contractors 2% NCI

DES 3% ORS (excluding DES) 4% NIAID OD (excuding ORS) NHLBI 5% NIMH 17% 6% NINDS NICHD NLM 18 Other ICs + FDA

6% 7% 11% 12 Customer Segmentation (cont.) NIH occupational injury/illness data FY02 23% Clinical Center employees 18% Office of the Director employees

7% DES 6% ORS, non-DES 5% OD, non-ORS 17% Contractors 11% NCI 6% NIAID

31% Other 22 ICs and the FDA 13 Customer Perspective Customer Satisfaction 14 External Customer Survey Is based upon the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) criteria for outpatient medical care Employees top 5 priorities 1. 2.

3. 4. 5. Competent, safe medical care Care in a timely fashion Effective communications with staff Clean, organized environment Respect and caring 15 OMS Customer Satisfaction Survey Results April 1995 and March 2001 Competent, safe medical care 4 2001 (n=100) 1995 (n=361) 3 2

Respect and caring 1 Care in a timely fashion 0 Effective communications with staff Clean, organized environment 4 = Strongly Agree, 3 = Agree, 2 = Disagree, 1 = Strongly Disagree

16 Customer Satisfaction (cont.) Percent of OMS customers that agreed or strongly agreed that medical care was provided in a timely fashion (wait < 15 min.) 1995, April 96.5 % of 361 1995, November 97.5% of 332 1996, April

not surveyed 1997, May not surveyed 1999, April 99.4% of 314 2001, February 98.0% of 100 17 Internal Business

Process Perspective 18 Block Diagram of Service Group Service Group and discrete service are one and the same: Provide Occupational Medical Services A more meaningful high-level view is provided on the next page 19 Maintain Safe Working Environment Provide Occupational Medical Services Patient Arrives Checks In

Evaluated by Health Care Provider Returns to Workplace 20 Deployment Flowchart 21 Occupational Medical Service Care in a Timely Fashion Process Map Friday, November 01, 2002 OMS Administrative Staff Patient Arrives at OMS and

requests evaluation OMS Triage Nurse OMS Clinician Personal Health Care Provider, Hospital or Urgent Care Facility Was there a scheduled appointment ? Yes No Update administrative data and notify OMS clinician of the patients

arrival Updates administrative data and notifies the triage nurse Perform Evaluation Evaluates the patient at OMS clinic Does the request fall within the OMS scope of services ? Yes Urgent Is the need

Emergent, Urgent or Routine ? No Discharge to Patients Health Care Provider Perform Evaluation Emergent Schedule an appointment Routine Schedule an appointment Perform Evaluation

Perform Evaluation Page 1 22 Conclusions from OMS Discrete Services Deployment Flowchart The OMS triage nurse plays a pivotal role in the operation of the Building 10 clinic. The triage nurse is responsible for determining: whether the request for service falls within OMS scope of services,

the relative urgency of the visit, and the level of care required. 23 Process Measures 24 OMS Survey Data - Visits With Appointments, March 2002 16.0 14.0 12.0 M in u tes 10.0 8.0 6.0 4.0

2.0 0.0 Acceptable Wait For Evaluation Actual Wait For Evaluation 25 Visits With Appointments Prior surveys set 15 minutes as a reasonable time a customer with an appointment may wait to be evaluated by an OMS provider. This survey redefined a reasonable wait as 5 minutes.

The average wait in this survey was 7.5 minutes The average was skewed by the time taken for preplacement medical evaluations and related laboratory visits. 26 OMS Survey Data - Visits Without Appointments - Triage, October 2002 6 5 5 5 5 5 5 5

M in ute s 4 3 2 1 0 0 0 (n=31) Emergency (n=44) Urgent Ideal Median Time to Triage (n=22) Routine

Actual Median Time to Triage (n=84) Triage Only 27 Visits Without Appointments Triage The expected wait to be evaluated by the OMS triage nurse is less than 1 minute for emergencies and 5 minutes or less for all other visits. The actual waiting time to be evaluated by the triage nurse was 0 minutes for emergencies and 5 minutes for all other visits. 28 OMS Survey Data - Visits Without Appointments - Appointment, October 2002

200 180 160 140 M in u tes 120 100 80 60 40 20 0 (n=31) Em ergency

Ideal Median Time to Appointment (n=44) Urgent (n=22) Routine Actual Median Time to Appointment 29 Visits Without Appointments Next Available Appointment Ideally, a visitor with a medical emergency will receive an appointment within 2 minutes. The median wait time for an appointment was 9 minutes. The most frequent reported wait was 0 minutes.

Ideally, a visitor with an urgent medical problem will receive an appointment within an hour. The median wait time for an appointment was 20 minutes. 30 Visits Without Appointments Next Available Appointment (cont.) Ideally, a visitor with a routine medical need will be offered an appointment within 3 hours. The median wait time for an appointment was 20 minutes. 31

Learning and Growth Perspective 32 Conclusions from Awards Data Annual bonus program for OMS employees. Awards based upon the employees Performance and Significant contributions that significantly enhanced the quality of OMS services, or made OMS a more enjoyable worksite 100% received a performance-based bonus.

30% received a bonus for a significant contribution. 33 Analysis of Readiness Conclusions What is the correct mix of skills and abilities to work in OMS? Customer service mentality - people skills 2. Communication skills 3. Common sense 4. Commitment to being part of a team 5. Technical skills (e.g., clinical competency, experience with OWCP, etc.,) 1. 34 Analysis of Readiness Conclusions

Implications of the wrong mix of skills, abilities or tools to carry out OMS mission? Longer waits, less efficient, and possibly, less competent care. Compromise OMS role in providing a safe and healthy work environment. In many instances this may only be an inconvenience. However, in some situations workers lives may be jeopardized (i.e., care for chest pain, asthma, anaphylaxis, exposures to HIV-1 and herpes B virus.) 35 Financial Perspective

36 Unit Cost Measures The units for OMS are the number of patient visits recorded. Consultations, medical reviews, presentations, and other services that do not involve direct patient care were not included. Costs for the OMS contract include the following: Contract staff costs

Computer application developer NIH personnel costs IT expenses Supplies and materials 37 Unit Cost Measures (cont.) FY02 FY03 Total Costs $2,494,988 $2,542,318 Total Visits 34,881 35,927

Cost/Visit $71.53 $70.76 38 Change in Total Cost Unit $71.60 $71.53 U n it C o st P e r P a tie n t C o n ta c t $71.40 $71.20 $71.00 $70.80 $70.76 $70.60

$70.40 $70.20 FY'02 FY'03 39 OMS Asset (Staff) Uti lization 60000 50000 5239 H o u rs W o rk ed 40000 30000 47155

20000 10000 0 0 1 28.48 FTEs Productive Hours Nonproductive Hours 40 Asset Utilization Measures OMS has 28.48 FTE Asset utilization = 90%

The 10% shortfall is the anticipated consequence of staffing OMS so that there are always clinicians available to attend to medical emergencies and requests for urgent care This percentage would be higher, if the OMS triage nurses routinely declined employee requests for immediate care for non-emergent medical complaints 41 Conclusions and Recommendations 42 Conclusions from ASA FY02 1. 2. 3. 4.

OMS has a well established QI program. Customer satisfaction for each of their 5 top priorities has been exceptionally high for the last 7 years. The increased average wait for appointments was largely due to the time required to construct a clinical record for workers receiving preplacement exams and language barriers. The triage system is working. 43 Conclusions from ASA FY02 (cont.) 5. 6. 7. The OMS triage nurse routinely accommodates employees desire to be seen immediately for routine services. The mechanism for capturing appointment

time for emergency medical care in this study was faulty. OMS staff increasingly rely on a customized software application for the operation of the Building 10 clinic. 44 Recommendations Repeat the study within the next two years and broaden the types of visits examined (e.g., return visits for occupational injuries, international travel, surveillance program visits). Request that individuals receiving a preplacement medical evaluation report to OMS 20 minutes before their scheduled evaluation. 45

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