Developing a Clinic Staffing Model for Ambulatory Care Primary and Specialty Clinics

Background of the problem: An adequate amount of clinical staff is a critical factor in providing quality care and ensuring positive patient outcomes. Recently, our organization changed our productivity measurement model from worked relative value units (wRVU) to encounters; with this change, leaders were challenged to staff their clinics based on the number of scheduled visits. Ambulatory care leadership staff used various methods to fill vacant slots within their clinics and also sent staff home when they had excess due to low-needs-low-census.

Method: Our plan involved creating a consistent workflow and tool that all ambulatory care leadership staff could use to operate their department accordingly. A pilot was created with five ambulatory care specialties, which included family medicine and many adult specialty clinics, totaling 37 departments.

Virtual meetings were held two times a week for leaders to discuss staffing needs as well as determine potential flexing ability. Prior to the meetings, leadership representatives from each clinic would update a shared staffing tool and that tool would be discussed in detail during the meetings. Each group would collectively decide which departments had the highest needs and transfer staff accordingly.

Outcome: Over the last eight months, we were able to fill 57.7% of our vacant positions. This was 643.5 filled shifts out of a total of 1114.5 unfilled shifts. Additionally, our region is sending less staff home and developing a culture where transferring to other departments is the new norm. As our pilot progressed, feedback from participants allowed us to shorten the length of meetings and decrease the frequency to weekly. Going forward, our group plans to add more specialties and increase the departments that participate.