University of Michigan Taubman Center
Taubman Center Hours Expansion:
Feasibility Analysis for Adult Pulmonary, Adult Nephrology, Adult General Otolaryngology Clinics
Final Report
To: Mrs. Katie Konson, Senior Project Manager, Ambulatory Care Services
Dr. Connie Standiford, MD, Executive Medical Director Ambulatory Care Services
Mr. Matt Bazzani, Chief Department Administrator of Family Medicine
Mrs. Tammy Ellies, Project Senior Manager and Lean Coach
Ms. Katie Schwalm, Engineering Fellow
Dr. Mark Van Oyen, University of Michigan Professor
From: IOE 481 Project Team 1
Mr. Nicholas Curry
Ms. Sarah Gombert
Mr. Daniel Varsanik
Date: December 10, 2013
TABLE OF CONTENTS
EXECUTIVE SUMMARY ...... I
INTRODUCTION ...... 1
Background ...... 1
Project Goal and Objectives ...... 2
Project Scope ...... 2
METHODS ...... 2
Conducted Interviews ...... 2
Performed Benchmarking ...... 3
Analyzed MiChart Scheduling Data ...... 3
FINDINGS FROM DATA ...... 4
Interviews ...... 4
Benchmarking ...... 4
MiChart Scheduling Data ...... 6
FEASIBILITY CHECKLIST ...... 13
Checklist Methods ...... 13
Checklist Findings ...... 13
Checklist Conclusions ...... 13
CONCLUSIONS ...... 13
RECOMMENDATIONS ...... 14
Feasibility Checklist ...... 14
Satellite Locations ...... 14
In Clinic Expansion ...... 14
OPORTUNITES FURTHER ANALYSIS ...... 14
EXPECTED IMPACT ...... 15
REFERENCES ...... 16
Appendix A: Interview Questionnaire for Clinic Managers ...... A-1
Appendix B: Interview Questionnaire for Urology Clinic Managers ...... B-1
Appendix C: Figures for Pulmonary Clinics ...... C-1
Appendix D: Patient Type and Provider Data Figures ...... D-1
Appendix E: Feasibility Checklist ...... E-1
Appendix F: Partially Completed Checklist for Clinics ...... F-1
LIST OF FIGURES
Figure 1: Adult Pulmonary new patient appointment lead time...... 6
Figure 2: Adult Pulmonary new patient appointment lead time by month...... 7
Figure 3: Adult Nephrology new patient appointment lead time...... 7
Figure 4: Adult Nephrology new patient appointment lead time by month...... 8
Figure 5: Adult General Otolaryngology new patient appointment lead time...... 8
Figure 6: Adult General Otolaryngology new patient appointment lead time by
month...... 9
Figure 7: Adult Pulmonary correlation between lead time and cancellations ...... 9
Figure 8: Adult Nephrology correlation between lead time and cancellations ...... 10
Figure 9: Adult General Otolaryngology number of new patient cancelations
by lead time...... 10
Figure 10: Adult Pulmonary new patient monthly appointment volumes ...... 11
Figure 11: Adult Nephrology new patient monthly appointment volumes...... 12
Figure 12: Adult General Otolaryngology new patient monthly appointment
volumes...... 12
Figure C-1: TC Adult Pulmonary new patient appointment lead time...... C-1
Figure C-2: TC Adult Pulmonary new patient appointment lead time by month ...... C-1
Figure C-3: Briarwood Health Clinic Adult Pulmonary new patient appointment
lead time...... C-2
Figure C-4: Briarwood Health Clinic Adult Pulmonary new patient appointment
lead time by month...... C-2
Figure C-5: Brighton Health Clinic Adult Pulmonary new patient appointment
lead time...... C-3
Figure C-6: Brighton Health Clinic Adult Pulmonary new patient appointment
lead time by month...... C-3
Figure D-1: Adult Pulmonary percentage of new patients seen within 4-weeks by
appointment type...... D-1
Figure D-2: Adult Nephrology percentage of new patients seen within 4-weeks by
appointment type...... D-1
Figure D-3: Adult General Otolaryngology percentage of new patients seen within
4-weeks by provider...... D-2
Figure D-4: Adult Pulmonary percentage of new patients seen within 4-weeks by
provider...... D-3
Figure D-5: Adult Nephrology percentage of new patients seen within 4-weeks by
provider...... D-4
LIST OF TABLES
Table 1: Hours of Operation Comparison ...... 5
Table 2: Number of new patients that need to be seen to increase access to 80% ...... 11
Table 3: Average number of new patients by appointment status ...... 12
ATTACHMENTS
Adult Pulmonary Supplemental Information
Adult Nephrology Supplemental Information
Adult General Otolaryngology Supplemental Information
EXECUTIVE SUMMARY
The University of Michigan Hospital’s ambulatory care (outpatient) clinics want to explore the feasibility of extending business hours because new patients are not seen within the desired timeframe. To study the feasibility of extending hours, a student team from IOE 481 at the University of Michigan has investigated the relationship between extending hours and new patient access in three specific clinics: Adult Pulmonary, Adult Nephrology, and the Adult General Otolaryngology clinics within the Taubman Health Center (TC). The team was asked to provide a general feasibility checklist and partially completed checklists for the Adult Pulmonary, Adult Nephrology, and the Adult General Otolaryngology clinics.
The team was also asked to provide analysis data pertaining to patient access for the Adult Nephrology, and the Adult General Otolaryngology clinics. One way the TC measures its performance is by patient access, which is determined by calculating the percentage of new patients have a completed appointment with a provider within 4 weeks of scheduling an appointment. The faculty group practice goal for the TC is for all areas to be operating at or greater than 80% new patient access. During a meeting, the Senior Project Manager stated that the clinics of Adult Pulmonary, Adult Nephrology and Adult General Otolaryngology have patient access rates below the faculty group practice goal of 80%.
Data Methodology
The following five sections describe the data collection and analysis.
Conducted Interviews. The team interviewed three clinic managers from the Adult Pulmonary, Adult Nephrology, and Adult General Otolaryngology clinics. The team developed a questionnaire to gain understanding of how the clinics run and the requirements for a clinic to run. The team interviewed the three clinic managers a second time with a feasibility checklist draft to gain feedback on the current content.
Performed Benchmarking with Urology. The Adult Urology clinic at TC launched extended hours in September 2013. The team used a questionnaire to interview the Adult Urology Operations Manager to gain information about the department’s extended hours program and research the development of the extended hours program.
Performed Benchmarking with Competitors. The team benchmarked select University of Michigan Health System’s competitors through phone calls and Internet research to find the hours of operation at clinics similar to those at the TC. The main competitors benchmarked are: the Mayo Clinic, Cleveland Clinic, Beaumont Health System, St. Joseph Mercy Hospital, Johns Hopkins, and the Henry Ford Health System.
Analyzed MiChart Scheduling Data. The team analyzed MiChart scheduling data from October 2012 to October 2013 for the Adult Pulmonary, Adult Nephrology, and Adult General Otolaryngology clinics in the TC. This data was used to calculate and analyze:
· New patient access
· New patient access by appointment types
· New patient appointment status
· New patient cancellation reasons
· New patient appointment status by month
· New patient appointment slots per month
· Access of each new patient provider
· Correlations between cancellations and lead-time
· The number of new patients that need to be seen to increase patient access to 80%
Data Findings
The following sections describe the findings from the data collection and analysis.
Interviews. The interviews with the 3 clinic managers of the Adult Pulmonary, Adult Nephrology, and Adult General Otolaryngology allowed the team discover that there are three main limitations in expanding hours: (1) specific ancillary services and testing, (2) provider type, and (3) patient preference for providers. The second set of interviews allowed the team to fill out the feasibility checklist for each of the three clinics.
Benchmarking with Urology. The interview with the Adult Urology department allowed the team to understand the possible use of satellite locations for extended hours.
Benchmarking Competitors. From benchmarking it was discovered that two of the University of Michigan Health System’s local competitors have extended hours via satellite locations.
MiChart Scheduling Data. From the MiChart Scheduling data the team found that for the Adult Pulmonary, Adult Nephrology, and Adult General Otolaryngology clinics the access rates are 72%, 50%, and 23%, respectively. To reach an access of 80% based on the data, the Adult Pulmonary, Adult Nephrology, and Adult General Otolaryngology clinics need to see 6, 10, and 11 new patients, respectively, per week.
Feasibility Checklist
The team developed a feasibility checklist that will be used by future clinics when considering extending hours. The feasibility checklist has been developed through interviews conducted with the Adult Pulmonary, Adult Nephrology, and Adult General Otolaryngology clinic managers, as well as the benchmarking with the Adult Urology Operations manager. The team developed a categorization of five main topics to be considered: (1) Market – Business Need, (2) Needs Assessment, (3) Operational Planning, (4) Financial Evaluation, and (5) Implementation Planning.
Conclusions
Each clinic’s needs differ according to in-clinic procedures. Clinics also use different ancillary services according to patient and provider need. It was discovered that some satellite locations currently offer Saturday hours for patient appointments and urgent care clinics. These satellite clinics offer the possibility to increase patient access via Saturday hours as a feasible option. Through benchmarking, the team discovered that four out of six of the University of Michigan Health System’s competitors do not offer extended hour services. The two competitors that do offer extended hours use satellite locations and are local competitors. The MiChart data showed that there is an access issue in the Adult Pulmonary, Adult Nephrology, and Adult Otolaryngology clinics operating at new patient access rates of 72%, 50%, and 29%, respectively. To reach an access of 80% based on the data, the Adult Pulmonary, Adult Nephrology, and Adult General Otolaryngology clinics need to see 6, 10, and 11 new patients, respectively, per week.
Recommendations
The following sections describe the recommendations for the feasibility checklist, satellite locations, and in clinic expansion.
Feasibility Checklist. The team recommends that before considering expanded hours a clinic should complete the feasibility checklist based on specific clinic information. After filling out the checklist, the clinic should perform MiChart data analysis to find access rates and correlations. Next, a patient survey should be created in order to find when patients would want extended hours, if they would go to them, and where. The clinic should then do a clinic staff survey to find out if staff willingness to flex their schedules or change hours. Lastly, the clinic should research direct competitors to see if they have extended hours and if they hold the hours at satellite locations or at their main campus.
Satellite Locations. A satellite location should only be used for extending hours on Saturdays. Some of the satellite locations within the University of Michigan Health System already offer Saturdays hours.
In-Clinic Expansion. Before considering expanding hours the following should be optimized to capacity:
· Rooms
· Providers
· Scheduling Template
· Equipment
If the clinic is currently operating at full capacity and is still considering expanding hours, the clinic should explore early or late expanded hours within the TC during the weekdays.
Opportunities for Further Analysis
To accurately compare the University of Michigan’s Health System’s competitors, the following subjects must be examined:
· Lead-time for competitors
· Access rates for competitors
· Number of patients seen daily
· Use of overbooking concepts
· Use of satellite locations
16
INTRODUCTION
The University of Michigan Hospital’s ambulatory care (outpatient) clinics are exploring the feasibility of extending business hours because new patients are not seen within a desired timeframe. The goal of the University of Michigan Hospital is to have its outpatient clinics have 80% of new patients seen within 4 weeks of making an appointment; currently that goal is not being met. An IOE 481 student team from the University of Michigan evaluated the feasibility of extending hours and/or implementing weekend hours. To study the feasibility of extending hours, the team has investigated the relationship between extending hours and new patient access in three specific clinics: Adult Pulmonary, Adult Nephrology, and the Adult General Otolaryngology clinics within the Taubman Health Center (TC). The team was asked to create a feasibility checklist presenting ideas to consider before launching extended hours for further use of other TC clinics, as well as data pertaining to patient access for the Adult Nephrology, and the Adult General Otolaryngology clinics. This project is a groundbreaking investigation for higher patient access rates within all the TC clinics. This report discusses the data the team analyzed along with the conclusions and recommendations the team is providing.
Background
IOE 481 team investigated the Adult Pulmonary, Adult Nephrology, and Adult General Otolaryngology clinics. The Adult Pulmonary clinic provides care for patients with acute or chronic respiratory disease. The Adult Nephrology clinic provides care for patients with a wide range of kidney diseases. The Adult General Otolaryngology clinic provides care for patients with disorders of the ear, nose, and throat, which also include the head and neck.
The Adult Pulmonary, Adult Nephrology, and Adult General Otolaryngology clinics operate from 8 am to 5 pm Monday through Friday and offer no weekend service in TC [1]. The clinics may need ancillary services such as radiology, phlebotomy, and possible other services during appointments. These services have their own separate hours that often differ from clinic hours [1].
Adult Pulmonary and Adult Nephrology share a total of 68 rooms with the following four other clinics in the TC: Gastroenterology, Infectious Diseases, General Medicine, and Rheumatology. These clinics require a certain number of providers and support staff, such as medical assistant, social workers, and nutritionists, to run the clinic.
One way the TC measures its performance is by patient access, which is determined by calculating the percentage of new patients that meet with a provider within 4 weeks of making an appointment. The goal for the TC is for all units to be operating at or greater than 80% patient access. The clinics of Adult Pulmonary, Adult Nephrology and Adult General Otolaryngology have patient access rates below the faculty group practice goal of 80% [2]. Some patients who are not seen in a desired timeframe may cancel and/or possibly find care elsewhere.
Project Goal and Objectives
The goal of this project was to explore the feasibility of extending clinic hours in the Adult Pulmonary, Adult Nephrology, and Adult General Otolaryngology clinics of the University of Michigan Hospital.
To reach the goal, the following aspects have been analyzed and considered:
· Patient Access
· Clinic scheduling