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Sheffield Contraception and Sexual Health Service

Sheffield Contraception and Sexual Health Service. Microsystems Approach to Improving the Drop-In Clinic. Our Service. Provide accessible, equitable and targeted Contraception and Sexual Health services for the residents of Sheffield Open access from 8.30am - 3.30pm

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Sheffield Contraception and Sexual Health Service

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  1. Sheffield Contraception and Sexual Health Service Microsystems Approach toImproving the Drop-In Clinic

  2. Our Service • Provide accessible, equitable and targeted Contraception and Sexual Health services for the residents of Sheffield • Open access from 8.30am - 3.30pm • Youth Clinic 3.30 – 6.00pm • Appointment clinics running alongside • In city centre – ease of access • Popular service – 100+ patients per day

  3. In the beginning… • Staff stressed, working overtime • Pressure on Reception • Waiting room full to bursting • Waiting time anything from 10m to 2hrs • Unable to tell patients how long they would be waiting. • Capacity uncontrolled – closing early when too many on list so patients being turned away

  4. Team Approach • Started in April 2013 • Multidisciplinary Team – invitation to all staff to express an interest • Began with Ground Rules and the 5 Ps • Lots of number crunching and measuring what we already thought we knew

  5. Mildred • Mildred is 21 years old • She lives in S5 • She is in a new relationship • Mildred has attended Drop In clinic for contraception advice • What does Mildred want from us? • What does Mildred need?

  6. Our Aims TO IMPROVE THE DROP-IN CLINIC WITHIN SCaSH THE PROCESS BEGINS WITH: • Patient arrives at clinic THE PROCESS ENDS WITH: • When the care is complete BY WORKING ON THE PROCESS WE EXPECT: • Reduced waiting times • Staff finish on time • Not turning patients away • To give each patient the time they need IT IS IMPORTANT TO WORK ON THIS NOW BECAUSE: • We need to improve the service to meet the changing demand of our patients

  7. Idea: Allocate Patients a Time Slot • How long should the slot be? • What happens if you run over? • What happens if you run out of slots? • What about emergency contraception? • How do you get a second opinion?

  8. Patient Survey We are considering ways in which we can change the Drop-In Clinic for the better and would be grateful for your opinion on the following. Would you prefer: • an appointment on the same day, or • to wait in a Drop-In clinic.

  9. First Trial • One morning only – capacity control using slots • 30-minute appointments • Patients could choose to go away and come back at their appointment time or sit and wait

  10. It didn’t work! • Didn’t have enough appointment slots • Patients were asked to come back to pm DI, which increased demand and staff stress levels • Some slots weren’t long enough • Some were too long • Reception staff constantly asking what to do with different patient requests

  11. Perseverance • 20 minute slots • Some appointments were double-length • Blocked one slot at the end for emergencies • Separate list for Implants • Introduced a “supporting clinician” role • Slowly increased duration of the trial until the system was adopted and we were “tweaking”

  12. The Experience • “Sometimes Frustrating” • Trying to get a consensus • Pace of change very slow – need patience and trust in the system • “Sense of having achieved something” • “Very happy when things work, very anxious when it doesn’t” • Team members’ responsibility on clinic floor – “YOUR Microsystem” – need to stay true to the cause. • “Take the rough with the smooth”

  13. Experience • “The meeting is a safe place to air your frustrations and negativity. There’s always someone to make you feel better.” • Excellent to reflect on how far we’ve come and what it was like before. • Doctor: “I’ve been off for 6 weeks and can’t believe what a great difference it’s made” • “Where are all the patients?” • “Makes you feel proud”

  14. Success!! Final Model: • Rebranded “Walk In Appointment Clinic” • Supporting Clinician role clarified • Positive Feedback from staff and patients • Worst week = 45 turned away; Last week = none! • Staff finish on time • Much calmer • Feeling of being in control of your working day and pace of working

  15. Challenges Ahead • From Jan 2014 • Integrated Sexual Health service: SCaSH and GUM • Managing patients across 2 sites • Working with different skill sets across 2 specialities • Offering holistic sexual health service

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