Valley State University's Medical Clinic

Valley State University's Medical Clinic

Valley State University operates a walk-in medical clinic to meet the acute medical needs of its 13,000 students, 1200 faculty and staff members, and covered relatives. Patients arriving at the clinic are served on a first-come, first-served basis.

As part of a new total quality management program, Valley State conducted an in-depth four-month study of its current operations. A key component of the study was a survey, distributed to all students, faculty, and staff. The purpose of the survey was to identify and prioritize areas most in need of improvement. An impressive 44 percent of the surveys were returned and deemed usable. Follow-up analysis indicated that the people who responded were representative of the population served by the clinic. After the results were tabulated, it was determined that the walk-in medical clinic was located at the bottom of the rankings, indicating a great deal of dissatisfaction with the clinic. Preliminary analysis of the respondents' comments indicated that people were reasonably satisfied with the treatment they received at the clinic but were very dissatisfied with the amount of time they had to wait to see a caregiver.

Upon arriving at the clinic, patients receive a form from the receptionist requesting basic biographical information and the nature of the medical condition for which treatment is being sought. Completing the form typically requires 2 to 3 minutes. After the form is returned to the receptionist, it is time-stamped and placed in a tray. Student workers collect the forms and retrieve the corresponding patients' files from the basement. The forms typically remain in the tray for about 5 minutes before being picked up, and it takes the student workers approximately 12 minutes to retrieve the files. After a patient's file is retrieved, the form describing the medical problem is attached to it with a paper clip, and it is placed in a stack with other files. The stack of files is ordered according to the time stamps on the forms.

When the nurse practitioners finish with their current patient, they select the next file from the stack and escort that patient to one of the treatment rooms. On average, files remain in the stack for 10 minutes, but this varies considerably depending on the time of day and the day of the week. On Monday mornings, for example, it is common for files to remain in the stack for 30 minutes or more.

Once in the treatment room, the nurse practitioner reads over the form describing the patient's ailment. Next, the nurse discusses the problem with the patient while taking some standard measurements such as blood pressure and temperature. The nurse practitioner then makes a rough diagnosis, based on the measurements and symptoms, to determine if the ailment is one of the 20 that state law permits nurse practitioners to treat. If the condition is treatable