Objective
• To understand the quality improvement process by applying the quality improvement tools to an improvement effort in an ambulatory care setting.
Your Job
• You have recently taken a position as a manager of two specialty clinics in a large multi-physician group practice in an academic medical center.
• The CEO of the practice has asked you to initially devote your attention to Clinic A to improve its efficiency which should ultimately improve patient satisfaction.
• The clinics (Clinic A and Clinic B) reside in the community and house primary
care and specialty practices as well as laboratory, and radiology.
General Clinic Information
• Clinic hours: Monday – Friday 8:00 a.m. – 5:00 p.m.
• First physician appointment starts at 8:30 a.m.
• Last physician appointment scheduled at 4:15 p.m.
• Closed for lunch 12:00 p.m. – 1:30 p.m.
• Closed major holidays
Clinic Employees
Clinic A Clinic B
Physicians 5 5
Nurses 3 3
Nurse Practitioners 1 1
Nurse Manager 1 1
Nursing Assistant 1 2
Front Office Personnel 3 3
Laboratory 1 1
Radiology 1 1
General Information
• The average number of patients seen per week: Clinic A – 325 Clinic B – 390
• The nurse practitioners do not practice on Thursday afternoons at either clinic.
• On Tuesday every week, one of the physicians at Clinic A teaches at the medical school, therefore does not see patients.
Picker Institute Data
• Patient Overall Satisfaction
Clinic A 68% Clinic B 93%
• Staff are Courteous and Helpful
Clinic A 80% Clinic B 89%
• Waiting Room Time Less than 20 Minutes
Clinic A 42% Clinic B 89%
• Exam Room Waiting Less than 20 Minutes
Clinic A 40% Clinic B 92%
• Patient No Show Rate
Clinic A 20% Clinic B 10%
• Patient Cancellation Rate
Clinic A 10% Clinic B 10%
• Pre-registration Completed Prior to Appointment
Clinic A 18% Clinic B 70%
Assignment – Part One
• After viewing the previous data for each clinic (A and B) answer the following questions:
1. List the potential problems you see in Clinic A that could affect efficiency.
2. Which of the data presented to you supports your decision?
3. Based on your identified problems, list the people in the clinic that you will invite to participate on a quality improvement team to help improve the process in this clinic (clinic employees list).
4. What fundamental knowledge will each bring to the table to help you solve this problem?
