Authors (including presenting author) :
Lam TMC, Chan SL, Chan BY, Yip KY, Leung KH, Leung SH, Chen XRC, Li YC
Affiliation :
KCC FM & GOPC
Introduction :
Upon re-delineation of cluster boundary of KCC and KWC in April, 2017, the Department of FM&GOPC of KCC has doubled up the number of clinics and the target deliverable of primary care attendance. In view of the increasing service demand and the tight manpower condition, the quota assigned for different services and programs of all 10 KCC community based GOPCs were aligned and closely monitored to optimize manpower deployment, maximize resource utilization and to minimize wastage.
Objectives :
1. To align service quota of GOPC consultations, FM specialist service, nursing and allied health service among all 10 community based GOPCs 2. To optimize quota use and to minimize quota wastage.
Methodology :
Department Quota Management Subcommittee (DQMS) was established in 3Q2017 and its members includes COS, DOM, two doctor leaders (one from ex-KCC clinics and the other from newly transferred ex-KWC clinics), three WMs and Shroff in charges from the community based GOPCs. The 1st phase started in 1Q18 focus on alignment of the quota sets for GOPC consultation, FM specialist, nursing and allied health service programs including Risk Assessment and Management Program in DM (RAMP-DM) and Hypertension (RAMP-HT), Integrated Mental Health Program (IMHP) and Wound Clinic service among all 10 community based GOPCs. The 2nd phase started from 1Q2019 focus on monitor of quota use by reviewing the service indicators such as the utilization rate (UR) and the default rate (DR) regularly. All DQMS members have agreed to set the pledges of UR at over 85% and DR at less than 15%. Monthly report of various doctor, nursing, allied health and special programs were compiled and circulated through DQMS members for regular review. Services not meeting the pledge were highlighted for respective subject officers to follow through monthly. The latest DQMS data released in 3Q2019 was compared with those in1Q2019 and the improvement strategies were reviewed.
Result & Outcome :
At 3Q2017, GOPC Dr consultation quota set was aligned across all GOPCs in both teams. From 2Q2018 to 4Q2018, the quota sets of various special programs in both teams were also aligned. Initial stock-take of the quota sets of ex-KWC GOPC special programs was done in 1Q2018 and they were aligned with existing KCC GOPC quota sets after thorough discussion among managers and frontline staffs cross both teams and was in place in 4Q2018. The first DQMS report was compiled in 1/2019 and it showed that around 11 service indicators from the above programs did not reach the target UR and DR pledge. After collective effort from both the management team and the corresponding subject officer and program coordinators, the number of these not-meeting-pledge service indicators (NMPSIs) had been reduced to around 5 in the latest DQMS data in 3Q2019. In particular, the quota use for IMHP kept improving as shown by continuous decrease in the no. of NMPSIs from 2.6 to 0.67. For ex-KWC GOPCs, RAMP-DM and RAMP-HT services showed continuous improvement with the average number of NMPSIs decreased from 0.67 to zero over the nine months of 2019. The continuous improvement was based on the following strategies: Firstly, the DQMS data was regularly shared with all subject officers and program coordinators. The relevant information was effectively communicated at meetings. Secondly, for sessions of under booking, grouping the quota of different sessions would optimize the use of manpower. In addition, manpower will be deployed to setting up extra sessions for service with long waiting time. Thirdly, “reminder call” to patients for selected programs would reduce the DR. Lastly, for programs with very high DR, overbooking was implemented to improve the quota use and to reduce the wastage. In conclusion, via a team approach with regular data-driven service review and proactive staff engagement,KCC GOPC team has been optimizing the quota use and in reducing the quota wastage,providing timely and accessible care for patients in the community.
