Good Neighbor Healthcare Center and the OC3 Journey

1
Good Neighbor Healthcare Center and the OC3
Journey

• Alan Simmons, DDS Dental Director
• Neeta Gautam, MD CMO
• Good Neighbor Healthcare Center
• October 25, 2008

2
Goals and Objectives

• Share the experiences of Good Neighbor Healthcare
  Center (GNHC) with implementation of OC3 from the
  medical and dental perspective
• Discuss challenges in implementation
• Discuss future plans

3
Goal of OC3

• See your own, dont make them wait
• Mark Murray, MD
• Principles vs. Strategies

4
Background

• GNHC in operation 35 years (FQHC since 2005)
• Mission care for the underserved in our area
• Started OC3 in 2006
• Moved into new site March 2008

5
Areas of Discussion

• Communication
• Front Desk/ Appointments
• Backlog
• Rooms and supplies
• Continuity
• Challenges
• Future Plans

6
Communication-Before

• Limited between departments
• Unclear understanding of roles/responsibilities
  of others
• Unclear reporting structure
• Limited with patients
• no news is good news
• Duplicate processes in different departments

7
Communication-Now

• Improved communication between departments
• More understanding of roles of others
• Improved with patients
• Lab letters, for example
• Streamlined uniform processes
• Reporting structure established

8
Communication-How?

• Weekly OC3 meetings
• KEY representatives of ALL involved areas
  present
• All contribute and all can make suggestions
• Meeting notes are record of work done and
  reminders for follow up

9
Front Desk/Appointments-Before

• Separate for Dental and Medical
• Separate income verification process
• For each department, check in, check out,
  messages, appointment calls, walk ins being
  managed by same staff
• Multiple forms for registration
• Medical Charts walked back to department
• Multiple appointment types and rules for
  appointments

10
Front Desk/Appointments-Now

• Centralized registration/income verification
  process
• Separation of tasks (phones, check in, check out)
• Streamlined registration forms
• Charts located in department
• Simplified appointment types

11
Front Desk/Appointments-How?

• OC3 Group reviewed registration forms and
  simplified process
• KEY Support of administration to implement
  changes
• Agreement to simplify appointment types and
  eliminate rules by providers, assistants, front
  office staff

12
Backlog-Before

• Dental-1.5 months
• Had to close panel to new patients
• Medical-NP WWE- 2 months
• Walk-ins
• Nurse triage time
• Squeezing in appointments

13
Backlog-Now

• Dental-1.5 weeks
• Able to see some new patients
• Medical-less than 1 week
• Fewer walk ins
• Education of patients about making appointments
• Nursing triage time decreased

14
Backlog-How?

• Max-packing
• Combining services in 1 visit
• Lab letters
• Reduce visits to discuss results
• Spacing out visit intervals as appropriate
• Doing todays work today
• Care of a panel of patients
• Appropriate space/staffing to meet demand
• KEY Measurement as means to determine if changes
  make a difference

15
Rooms and Supplies-Before

• Bottleneck-number of rooms/dental chairs
• Time wasted in looking for supplies
• Rooms not stocked uniformly or regularly

16
Rooms and Supplies-Now

• Increased number of rooms and dental chairs
• Each room supplied identically
• Dental tub and tray system
• Rooms restocked weekly
• Reminder system for ordering supplies

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Rooms and Supplies-How?

• Fortunate to move new site with more space
• Medical medical assistants responsible for
  stocking own rooms
• Dental all responsible for stocking all stations
• KEY The principle is the same, but the solutions
  are different based on needs

18
Continuity-Before

• Medical-virtually non-existent
• No panels
• Pts seen in an all hands on deck approach
• Dental-continuity present
• Same provider throughout treatment plan
• No panels

19
Continuity-Now

• Medical
• Continuity emphasized
• Made easier with provider panels
• Provider and medical assistant partner together
  to care for panel
• Dental
• Continuity remains
• Now providers have responsibility to manage a
  panel of patients

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Continuity-How?

• Assigning patients to providers
• Took months
• KEY Providers saw it was faster and easier to
  see own patients and bought into idea of
  continuity
• Re-enforcement of need to maintain continuity at
  meetings
• Education of patients to expect to see same
  provider each visit

21
Challenges

• Early efforts in educating staff, providers in
  OC3 terminology and how to view work differently
• Appropriate people in OC3 meetings
• Establishing momentum of meetings and changes
• Understanding measures and seeing measures as
  useful information, not judgment

22
Future Plans

• Electronic Medical and Dental Records
• Tool to improve access, data retrieval and reduce
  time looking for charts
• Ongoing Participation in OC3
• Goals as part of work culture
• Working to improve communication in and among
  departments

23
Goal of OC3

• See your own, dont make them wait
• Mark Murray, MD
• Principles vs. Strategies

24
GNHC OC3 Team-Partial