WIC Program Patient Flow Analysis

Each clinic director composed an aim statement, which are listed as follows: • Ellis Shipp Clinic: By December 2013, WIC staff will decrease the waiting time for a nutritionist by 30%. • Rose Park Clinic: Reduce the average gross waiting time by 15% for WIC participants by December 1, 2013. • Salt Lake City Clinic: Reduce overall appointment time from 59 minutes to 50 minutes by December 31, 2013. • South Main Clinic: Food instrument appointments will decrease from 24.1 to 18 minutes. • Southeast Clinic: By December 31, 2013, the WIC staff will decrease the vouchering wait time by 10%. • West Jordan Clinic: Reduce the recertification process by 10 minutes by December 31, 2013.

Team leaders in each of the six WIC clinics requested an analysis to quantify their patient flows. Each clinic uses a different approach for managing patient flow. Although they vary greatly, there are strengths in at least one area of patient flow in each clinic. The team leaders analyzed the patient flow to measure differences among all clinics, then integrated the most effective components of each to standardize practices and improve effectiveness overall.

WIC clinics in Salt Lake County provide a meaningful service to women, infants, and children with greater needs. By providing supplemental nutritious foods to underprivileged families, WIC helps to ensure that these individuals eat a healthier diet during these pivotal life stages. However, some individuals could be participating in WIC but are not. Because of a variety of perceived and real barriers, some women choose not to participate. Shorter wait times at WIC clinics have been shown to be related to participants who use their WIC checks more often, as well as a decreased sense of barriers in using WIC services (Woelfel et al., 2004). To decrease waiting times in health service delivery settings, CDC has made available a program to help record and analyze patient flow data. By using this program, clinics can be compared and analyzed to find areas to improve. In each participating clinic, barriers were identified by brainstorming with experienced staff. Summary conclusions from each clinic are as follows: Ellis Shipp Clinic • The waiting time to see the nutritionist was 7.91 minutes. • Clients arrive early. • Large families take longer. • Packets were skipped. • Side jobs are done during clinic time. • Nutritionists are talking with each other. • The clinic is short on staff. Rose Park Clinic • Average gross waiting time for certification was 16.98 minutes. • The class was not communicated well to participants. • Nutritionists do not communicate well that they need to leave for class. • Nutritionists do not communicate to office staff until the last minute that the client was given a bulletin board. • The clinic overbooks appointments or allows clients to arrive earlier than their appointment time. • Scheduling could be improved. • Clients ask for an interpreter (Spanish). • Care plans are written after the client leaves. • Clients are called back to the nutritionist's office to make food package changes. • The nutritionist is not communicating when he or she leaves the voucher desk. • Staff answer personal calls before helping clients. • Clients/staff do not ask for help from the nutritionist. Salt Lake City Clinic • Nutritionists perform vouchering. • Family sizes are large. • Children run around the clinic. • Breast pump issuance could be improved. • Prescriptions are not ready. • Staff members must explain checks to new clients. • There is difficulty with finding prescriptions. • There are problems with immunization notes. • Some clients have multiple issues. • Front desk staff are overly busy during class. • Multiple packets are given to the nutritionist at once. • Babies may not be ready for the laboratory. • Efficiency in job-specific tasks could be improved. Southeast Clinic • Waiting time for vouchering was 2.83 minutes. • Food packages are not in VISION and ready to print. • Clients are not certified by a CPA. • Packets are printed out of order. • There is no designated staff member to help with vouchers. • Laboratory staff are not helping with vouchering. • Clients are not available. • Staff are busy at the front desk and cannot help with vouchering. West Jordan Clinic • The recertification process takes 71 minutes. • Participants do not have all of the proof needed for certification/recertification. • There are unscheduled formula changes. • Family sizes are large. • Explanations of food cards could be improved. • Children are afraid of the laboratory. • Space is limited. SOURCE Woelfel, M. L., Abusabha, R., Pruzek, R., Stratton, H., Chen, S. G., & Edmunds, L. S. (2004). Barriers to the use of WIC services. Journal of the American Dietetic Association, 104(5), 736–743. Retrieved from http://www.sciencedirect.com/science/article/pii/S0002822304002342

The inefficient workflow caused bottlenecks that interrupted smooth operations.