The GCPHD Family Planning Clinic Director retrospectively collected data on visit time for the prior month using a daily sample of patient data.

QUESTION-

Using data for quality improvement 

Describe the measures your team might want to collect. For each measure, state what category of measure it is (structure, process, outcome, or balancing), how it could be collected, and why is it important. 

Your aim is to decrease Total Visit Time (the time from registering patients at the front desk to completing the visit).   The GCPHD Family Planning Clinic Director retrospectively collected data on visit time for the prior month using a daily sample of patient data. You decide to analyze the baseline and create the chart below: 

CHART A: Length of visit in the GCDPH Family Planning Clinic 180 time of visit (min 1 2 3 4 5 6 7 8

9101112131415161718192021222324252627282930 Visit Day

Explain to your team what type of chart this is and why you chose to use it.  What does the chart included above tell you about the clinic process? What other questions might you want to answer about the process?  What other types of graphs might you use to help understand the process?

3. How would you know if the change idea you identified (to assign specific roles and tasks to different members of the clinic staff), and tested by PDSA cycles led to improvements?

Reference:Case scenario

The Guilford County Department of Public Health (GCDPH) in Greensboro, NC, provides family planning services to women and men. Services are offered at three different locations in the county, collectively completing approximately 7000 visits annually.  Services provided include physical exams, birth control, health education, counseling, laboratory tests, pregnancy tests, and testing and treatment of sexually transmitted diseases. Visits can include interaction with a number of staff including reception and intake staff, lab techs, nurses, physician assistants, and physicians.

County-specific data on the need for or use of family planning services are not routinely collected. The most recent state survey (Behavioral Risk Factor Surveillance Survey) from 2016 indicates nearly half (49%) of women of reproductive age are at risk of unintended pregnancy.

GCDPH is increasingly being asked to do more without being provided more resources. They have a four-week wait time for appointments and are looking for ways to increase clinic efficiency in hopes of seeing more patients to reduce their wait time for appointments.

You were recently hired at GCDPH as a project manager and have been asked to help with this quality initiative because the health director learned you had taken a quality improvement course in your MPH program. Most of the staff working in GCDPH Family Planning Clinic have many years of experience and excellent clinical skills, but few have experience with CQI and none have an MPH. 

You wisely decided the first task was to form a CQI team.  The team has met and set the following aim:

We aim to increase the use of family planning services for men and women of reproductive age in Guilford County by July 2022.  This is important because higher use of family planning allows spacing of pregnancies and prevents unintended pregnancies and associated health risks. We will achieve this aim by using QI methods to streamline our family clinic services, decreasing the total visit time from 2 hours to one hour.  This will allow us to increase the number of patients we see per day and reduce the wait time for appointments.

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