FY02 ASA Presentation Occupational Medical Service, DS Medical Care in a Timely Fashion

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FY02 ASA Presentation Occupational Medical
Service, DSMedical 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

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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..

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Introduction
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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

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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

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OMS QI Efforts (cont.)

• Customer Satisfaction Surveys prior to the ASA
• External customer (employee) surveys
• April 1995, November 1995, April 1996,
• May 1997, April 1999, March 2001
• External customer (supervisor) survey
• October 1997
• Internal customer (OMS) surveys
• August 1995, June 1996

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ASA Template
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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

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Customer PerspectiveCustomer Segmentation
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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

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Customer PerspectiveCustomer Satisfaction
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External Customer Survey

• Is based upon the Joint Commission on
  Accreditation of Healthcare Organizations (JCAHO)
  criteria for outpatient medical care
• Employees top 5 priorities
• Competent, safe medical care
• Care in a timely fashion
• Effective communications with staff
• Clean, organized environment
• Respect and caring

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Customer Satisfaction (cont.)

• Percent of OMS customers that agreed or
  strongly agreed that medical care was provided
  in a timely fashion (wait lt 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

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Internal BusinessProcess Perspective
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Block Diagram of Service Group

• Service Group and discrete service are one and
  the same
• A more meaningful high-level view is provided on
  the next page

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Deployment Flowchart
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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.

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Process Measures
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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.

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Visits Without AppointmentsTriage

• 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.

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Visits Without AppointmentsNext 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.

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Visits Without AppointmentsNext 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.

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Learning and Growth Perspective
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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.

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Analysis of Readiness Conclusions

• What is the correct mix of skills and abilities
  to work in OMS?
• Customer service mentality - people skills
• Communication skills
• Common sense
• Commitment to being part of a team
• Technical skills (e.g., clinical competency,
  experience with OWCP, etc.,)

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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.)

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Financial Perspective
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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

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Unit Cost Measures (cont.)
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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

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Conclusions and Recommendations
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Conclusions from ASA FY02

• 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.

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Conclusions from ASA FY02 (cont.)

• 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.

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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.