COUNTY OF SAN MATEO

Inter-Departmental Correspondence

San Mateo Medical Center

 

DATE:

May 8, 2003

   

BOARD MEETING DATE:

June 10, 2003

 

TO:

Honorable Board of Supervisors

FROM:

Nancy J. Steiger, Chief Executive Officer

 

SUBJECT:

Medical Center Reorganization: Clinics Division

 

Recommendation

Adopt an Amendment to the Master Salary Ordinance as follows, within the Clinics Division of San Mateo Medical Center:

    1. Delete two Administrative Assistant positions at 39th Avenue

    2. Add one Clinics Manager position at 39th Avenue

    3. Delete one Lead Patient Services Assistant position and add one Patient Services Supervisor at 39th Avenue

    4. Delete one Clinical Nurse position and add one Charge Nurse at 39th Avenue

    5. Add one Staff Physician (to replace a contract position) at Willow Clinic

    6. Increase one Staff Physician position from part time (0.5FTE) to full-time

    7. Increase and reclassify one part time Staff Physician position to a full-time Supervising Physician.

 

Background:
In pursuit of our mission to open doors to excellence in health care, one of our top priorities in the Clinics Division is to expand patient access to care and to decrease the waits for appointments. Our strategy to accomplish this without increasing net county cost is two fold. The first is to improve clinic through output and efficiency, so more service can be provided with existing physicians and staff. Accomplishing this requires the right management structure, with appropriate workload, and accountability for outcomes. The second strategy is to optimize the physician-to-support staff ratio, so that the same support staff can support more physicians. This spreads the fixed overhead over more visits, decreasing the total cost/visit and increasing access and revenue. This project aims to accomplish these two goals with a slight decrease in support position costs, and an expansion of net revenue-generating physician positions.

 

Discussion

The first four items relate to 39th Avenue Clinics management structure. They flatten the structure, reducing layers, and increasing local accountability and authority. Currently, there is one Clinic Manager at 39th overseeing two floors, when the patient volume and staff size are double that of other Clinic Managers. To manage that volume, the clinic uses an assistant manager and an Administrative Assistant, but this has created excess layers of management with insufficient local accountability.

The recommendation is to flatten the structure, by replacing the Administrative Assistant with a second Clinic Manager, to allow one for each floor. This would give them patient volume responsibility commensurate with like Managers. The budget for this would be achieved by deleting two currently vacant Administrative Assistant positions. Clerical supervision at 39th Avenue, likewise, has too many layers, and the recommendation is to allow more local accountability by deleting a Lead Patient Services Assistant position and adding a Patient Services Supervisor.

The two Charge Nurses at 39th Avenue, likewise, oversee staff and volume that is double the other sites. The recommendation is to delete a Clinical Nurse, and add a Charge Nurse position, at the same salary and benefits.

Augmenting physician positions while holding support staff constant, is one of our two simultaneous strategies for improving efficiency and lowering costs per visit. It allows immediate revenue generation to offset the fixed overhead costs of support staff and other expenses, while simultaneously meeting community need for more access.

Pediatric services at Willow Clinic used to be provided through a Stanford University contract. This contract was terminated in July, 2002 due to unsatisfactory performance. Since then we have been partially backfilling with extra-help, but have not completely filled this, and we have had reduced volume as a result. We recommend creating a permanent position to replace the contract position.

We currently have two vacant 0.5 FTE physician positions. We have been unable to fill them for over eight months because applicants have only been interested in full-time, or near full-time positions.

We recommend increasing one 0.5 FTE position to 1.0 FTE to allow successful recruitment of the position, as well as to generate additional revenue.

We also recommend converting the other 0.5 staff physician position to a 1.0 FTE supervising physician position. This will allow us to provide supervision and improved productivity of "Chronic Disease Management" services across all clinic sites that are currently poorly coordinated. Assigning a supervising physician to this activity should optimize utilization and quality. The position would be a 70% clinical, 30% administrative position, to be self-supporting through patient revenue.

 

Vision Alignment

This reorganization will allow the organization to keep the commitment of Ensuring Basic Health and Safety for All and goal number 5: Residents have access to healthcare and preventative care. This Ordinance contributes to this commitment and goal by improving efficiency and facilitating community access to services.

 

Fiscal Impact

The non-physician changes will have a net savings of $28,000/year in salary & benefits. The physician changes are expected to net $128,000 in patient revenue after salary expenses. Beyond these direct fiscal impacts, these changes will create the organizational structure needed to meet San Mateo Medical Center's broader fiscal goals. These changes will be reflected in the recommended San Mateo Medical Center's FY03-04 budget.