Improving services at the West Valley Planned Parenthood clinic, West Valley, Utah



Clients can pick-up their contraceptives at the check out desk before they leave the clinic.
 
When clients came to the West Valley Planned Parenthood, outside Salt Lake City, Utah, they had to plan to wait. An average visit took clients an hour and 15 minutes from when they walked in the door to check out. As the client population has grown and changed, the West Valley clinic has needed to adapt to those changes. When the building was first built in 2003, it was designed to meet client needs in the area for 10 years. The population outgrew the facility within two years, and in 2005, the West Valley Planned Parenthood recognized that the dramatic growth in the community was impacting client satisfaction and services. The clinic asked JSI to help them examine their systems, improve efficiency, and streamline client visits.

Previously, the clinic had two check-in windows—one for exams and one to pick up medicines. Every day, the line to check in for an exam extended through the large waiting room while the other window was typically empty. There was little space for service providers and clinical assistants to write up client notes and check-out was a cumbersome process, as it was handled in the same space as check in.

Today, with only a few simple, practical changes, client waiting time has been cut dramatically; clients now spend between 38 and 45 minutes in the facility for a full examination. If there just for counseling and tests, the visit time is down to 20 minutes.


The drop down chart tables have given clinicians valuable space to take notes and complete charts.
The signs directing patients to a certain window in the reception area have been taken down and clients can step up to either window that is attended. Furthermore, a new initiative called "Grab-&-Go" enables an available provider to take a client directly into an intake or exam room, bypassing the front desk and reception wait time. Client information is entered into the computer later at visit completion. Both the staff and clients like this new approach, which has cut down on the bureaucracy of client check in.

Practical physical changes have also been made at the clinic. Drop-down chart tables are now available on the walls, so clinicians have a space to write-up notes. Each examination room now has its own supplies, such as blood pressure cuffs and Depo Provera® contraceptive injections. Perhaps the most important physical change was creating a separate space for client check out. As clients leave the facility, they now leave by a different door. The paperwork for entering and exiting clients is kept completely separate (previously they were occasionally mixed up in the same space). Clients can also get their contraception upon check-out.

There is a more streamlined patient flow through the clinic. Patients now take their pregnancy tests in the restroom before getting counseling in the intake room. Patients are now only taken to an intake room when they receive results of any kind.


A drive-through window enables clients to pick-up their contraceptives or other supplies without entering the clinic.
 
All these physical client flow changes have been made possible by a changed management approach. Today, services—and the entire staff's approach—are client-centered, so women, men and families can get what they want and need as easily as possible, be it birth control, or an STD test. The facility used to have a manager-based approach, in which managers wrote-up all the issues and essentially controlled what got changed. The clinic has moved to team-based approach where everyone has input—which can be provided anonymously, if they feel the need. Staff are now encouraged to improve processes and to question why things are done in a certain way to determine whether they can be improved.

The redesign has clearly improved the quality of care and increased client satisfaction. While client appointments are shorter, patients recognize that services are more streamlined and do not have a negative effect on patient care—if anything, patient care has improved.

JSI has conducted this clinic efficiency redesign process as a component of its work for the Office of Family Planning, Office of Public Health and Science, Department of Health and Human Services. Under the HHS grant, JSI coordinates the Region VIII Family Planning Training Center, which provides cost-effective training—including the clinic efficiency process—for health care providers and staff of federally-funded family planning programs.

"JSI has helped us tremendously," says Carli Hess, Area Coordinator. "Change never comes easily, but staff see how much better things are now. As new staff join it is easier to implement JSI's clinic efficiency redesign. At first some staff would revert back to old habits, but now everyone is on board."