developing workflow process diagrams to target interventions
DESCRIPTION
Developing Workflow Process Diagrams To Target Interventions. Moderator: Mindy Golatt , RN, MPH, Public Health Analyst, HRSA/HAB Presenters: Paul Cassidy, Program Director, GNBCHC Erika Harding, Health Administrator, CCHC - PowerPoint PPT PresentationTRANSCRIPT
Developing Workflow Process Diagrams ToTarget Interventions
Moderator: Mindy Golatt, RN, MPH, Public Health Analyst, HRSA/HABPresenters: Paul Cassidy, Program Director, GNBCHC
Erika Harding, Health Administrator, CCHCFacilitator: Nanette Brey Magnani, NQC/HIVQUAL QM Consultant
Learning OutcomesParticipants will be able to:• Define the steps and symbols used in
workflow process diagrams,• Engage in discussion with grantees about their
examples, and• Begin to develop a workflow process diagram
of their own work processes.
AgendaQI Principles and FrameworkWorkflow Diagrams
The BasicsExamples
Try it out!Post AGMDiscuss and Revise with your Team.
Why Look at Processes?Fundamental Concept of Improvement:
“Every system is perfectly designed to achieve exactly the results it achieves”
Principles of Improvement:– Understanding work in terms of processes and
systems– Developing solutions by teams of providers and
patients– Focusing on patient needs– Testing and measuring effects of changes
Review: QI Principle Most problems are found in processes
not in people.
Understanding Work in Terms ofProcesses and Systems
Benefits• Clearer understanding of the overall system and processes• Target processes that need improvement• Efficient allocation of staff and resources• Effective use of team’s input and creative problem solving• Better understanding of each other’s roles• Reduction in waste and time
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What are your initial thoughts about this improvement system?
What are your initial thoughts about this improvement system?
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When do you develop your workflow diagram?
QI Project StepsStep 1: Review, Collect and Analyze Baseline DataStep 2: Develop a Project Team Work PlanStep 3: Investigate the Process/Problem Step 4. Plan and Test Changes – PDSA CyclesStep 5: Evaluate Results with Key StakeholdersStep 6: Systematize Change
QI Principle
Most problems are found in processes not in people.
– A system is made up of processes
– Processes comprise steps
Workflow Diagram Definition
A workflow diagram or flow chart is a picture of the steps of a process to: – Understand the process– Identify potential problem steps and reasons – Outline the ideal process steps– Enable communications with others
Creating a Process Diagram1. Agree on use and level of detail2. Define starting and ending points3. Document each step 4. Follow each branch to the end 5. Review the chart .
Flowcharts
Testing and Measuring a Workflow Process
1. Identify key problem steps.2. Write key causes to each identified problem3. Select interventions that address key cause.4. Then test and measure new process.5. Repeat as necessary.6. Support new process – e.g. communication,
new procedure guidelines.
Most Commonly Used Flowchart Symbols
Activity/step
Begin/Terminator
Decision
Connecting lines
Flowcharts
Grantee ExamplesVL Suppression
• Paul Cassidy – Greater New Bedford CHC, New Bedford, MA
Gap in Care and Patient Transition to a different clinic
• Erika Harding – Christian CHC, Chicago, IL
Greater New Bedford Community Health Center, MA
Performance Measure for VL Suppression
Percentage of HIV patients, regardless of age, with a viral load less than 200 copies/ml at last viral load test during the measurement year.
Measurement year 2011
Viral Load Suppression
84
236
Number of Patients = 320Suppressed (Blue)= 236Not Suppressed (Red)=84Suppression Rate=73%
Baseline Data
Improvement Goal
To increase patients’ viral load suppression rate from 73% to 85% in six months.
Causal Analysis
Problem Steps with Workflow processes on two levels:
Patient Level• Insufficient time for adherence education for patients not suppressed
Causal Analysis cont’d
Problem Steps with Workflow processes on two levels:
Program Level• Weekly (3x/month) multi disciplinary team meetings for patient review had stopped meeting for 6 months due to construction; thus a loss of focus on non suppressed patients• Minimal input of multidisciplinary team members ideas into tailored care plans for each non suppressed patient• No feedback loop for reporting results of the interventions back to the team.
Lab Blood Draw
Call patient and make earlier visit than previously scheduled
PATIENT REGISTERS
MA TAKESVITALS
PHYSICIAN EXAMINESPATIENT, REVIEWS RESULTS AND REGIMEN
Review Meds, barriers to adherence, based on barriers, pre-pack meds, deliver to house, review meds and fill pill box
Determine next steps with patient **
Give lab orders, patient to Lab
Order Blood work for next three month review
Schedule next visit
Lab Results sent to Physician
Lab Results Sent to RN
Lab Results Sent to Data Entry. Blood work electronically entered into EHR
Concern with Results
No further Follow-up
YN
GNBCHC Workflow Process for Established Patients
RN Adherence Visit
Multi-Disciplinary Team Review
<200
>200
RE- START WEEKLY MTGS-3/MONTH•REVIEW PATIENTS•TAKE NOTES•DEVELOP CARE PLAN TEMPLATE•DEVELOP PATIENT SPECIFIC CARE PLANS•TEAM MAKES RECOMMENDATIONS•ASSIGNED STAFF PRESENT PLAN TO PATIENT FOR PATIENT INPUT•FOLLOW –UP ON RECCOMENDATIONS•INTERVENTION IS INDIVIDUALIZED
Prepare Reports
Identifying Patients Not Suppressed.
RN INTERVENTION•DEVELOP AND IMPLEMENT CARE PLAN•FOLLOW -UP
SOCIAL WORK INTERVENTION
•FOLLOW-UP ON PLAN
PEER NAVIGATORINTERVENTION
•FOLLOW –UP ON PLAN
SCHEDULED TEAM MEETINGS-REVIEW RESULTS OF
INTERVENTIONS# OF PATIENTS WITH VL >200 REVIEWED# WITH TARGETED CARE PLANSPATIENT RESPONSE TO INTERVENTION
DATA ENTRY
GNBCHC WEEKLY MULTI DISCIPLINARY MTGS.
***BARRIERS TO VIRAL LOAD SUPRESSION•SUBSTANCE ABUSE•HOMELESSNESS•NOT ATTENDING APPOINTMENTS•MENTAL HEALTH ISSUES•REFUSE MEDICATIONS
GNBCHC – Measurement• Data Update
Christian CHC: Improvement Goals
To reduce the gap in care rate from 13% to 5%. (number of patients with a medical visit in the last 6 months of the measurement year)
To ensure 170 patients or 69% of our HIV+ population at the Monterey Clinic are successfully transitioned to the Halsted Clinic.
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Quality Improvement Team
GROUP PHOTO HERE
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Patient Makes Appt.?
Appt Kept.
?
Patient Registers
Repeat call from PHAScheduler
Transition Care from Monterey to Halsted
CCHC Patients notifiedInstructed to make appt at different site
Yes
No
YesNo
Requires Follow-up
Receives reminder call from PHA – 1 day prior
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Patient Follow-up
Document status in list and chart
PHA meets monthly with QI Team for patients’ status update
Refer to Schedulerfor appointment
Import list of patients from CAREWare who’s last visit >45 days
Note appt datein Patient
Tracking Tool
Yes NoPatient
Has a Scheduledappt?
Active,Continuing?
Yes No
Data specialist initiates Patient
Tracking Tool
Refer names to Patient Health Advocate for follow-up
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Measurement Tracking Data
Yr Ending
Sept 2011
Nov2011
Jan 2012
Mar 2012
Apr 2012
May 2012
Rate 13% 16% 18% 7% 6% 8%
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Measurement Data
4%
8%
12%
16%
20%
Sep-11 Nov-11 Jan-12 Mar-12 May-12
Cycle 1 Ends
Cycle 2 Ends
Start PSDA
Cycle 3 Ends
Task: Draw a Workflow Process Diagram
1. Select a process to improve. It can be just a few steps.
2. Agree on use and level of detail.3. Define starting and ending points4. Document each step. Use paper provided. 5. Follow each branch to the end 6. Review the chart.
Flowcharts
Large Group DeBrief
What improvement processes did you choose?Who will share your diagram?What were some of your challenges?What do you think are the benefits?What can you do post AGM?
Flowcharts
REMINDER
This is a TEAM effort!
Flowcharts
Contact Information
Paul Cassidy, Program Coordinator, Greater New Bedford Community Health Center, New Bedford, MA [email protected]
Erika Harding, MPH, Health Administrator, Christian Community Health Center, [email protected]
Flowcharts
Contact Information
Mindy Golatt, RN, MPH, Public Health Analyst, HRSA/HAB, Project Officer/Chicago, [email protected]
Nanette Brey Magnani, EdD, Quality Management Consultant, NQC/HIVQUAL, [email protected]
Flowcharts