Issues we are facing Many schedule changes Vague requests Too many unexpected staff changes Managing flexible scheduling Improve access Satellite clinics Improve access without shuffling people Reduce waste
Too many schedule changes A number of them have been out of our control. One physician left the group and 5 providers our on sick leave. But how can we improve the current system
Things to consider whensubmitting your request BE AS SPECIFIC AS POSSIBLE If you need a day off request a VACATION on the schedule Order of preference SICK LEAVE>VACATION>EDUCATTIONAL LEAVE 6/10, 8/10/9/10 comp off days are flexible If requesting Friday or Monday vacation then let me know what you would like for the weekend. Don’t be as one of the extremes
Things to consider whensubmitting your request Don’t use symbols such as X or O or blank space since they lead to mistakes and misunderstandings. Use the following terminology VACATION NO CALL CALL SICK LEAVE 6/10, 8/10, 9/10 OFF (These requests are flexible) AT or IW with committee meeting detailMore detailed you are easier it is
Steps we are implementing When the schedule is completed It will be submitted for your review and you can request changes at that time. When the schedule is published then changes will be done only on case by case Will start the self scheduling module on AMION.COM
Do more with much less
What is the fiscal cliff During dept ceiling negotiations congress set up a bipartisan committee, the supercommittee, to address the budget deficit and cut the deficit by 1.2 trillion in 10 years. If they did not agree on a compromised plan then nother part of the Budget Control Act directs automatic across-the-board cuts (known as "sequestrations")
Why should I care? Mandatory 300 billion dollar cut from the medicare and medicaid fund More taxes 40 K/year $ 3000 100 $ 8000 200 $ 12000 300 $ 16000
Very inefficient system One area of waste in our department has been scheduled cesarean sections. We perform 50-60 scheduled cesarean sections per month 5-10 deliver at other facilities and the patient delivers prior to the scheduled cesarean section and the schedule is not modified and goes to waste.
we are witnessing history as it happens.
Current system We devote ½ W per cesarean section and one hour of traveling time if provider travels from the satellite clinic 30% of the cases are bumped and do not go on time Great source of frustration on providers and patients Problem with the lack of providers and access issue.
Solution Arrange the call schedule around the schedule cesarean section que. The primary surgeon will do the surgery It is a patient satisfier Eliminates the need for other providers to perform the cesarean section Potentially can add 30 W of clinic access per month to the schedule
Rational against it We are busy Not true: 2 years ago we used to deliver about 350 babies per month and now we are down to 240 per month Due to shortfall of deliveries we might lose our CNM 2 spot and by scheduling Cesareans on call we can protect the above.
What to expect? 1-2 scheduled cesarean section per call day. If more than 2 per provider then will arrange a per diem physician to cover the labor and delivery for that period.
What to do? try to do the cesareans with the CNM staff on call that day Delay the case as needed depending on the volume on the labor and delivery