Patient-focused access eases scheduling woes
System facilitates patient-driven scheduling
There’s a hot topic among members of the Dartmouth-Hitchcock Health System in northern New England: improving patient access to care. Aims for this project include gaining insight into the current scheduling practices and processes and their impact on patients and frontline staff. It is also intended to facilitate multidisciplinary team discussions to create "patient- driven" scheduling.
The notion of patient-focused access is based on the idea that facilities "do today’s work today." Appointments are available every day to any patient who wants an appointment, regardless of his or her health status. Patient-focused access, or open access, eliminates backlog, reduces cost, and increases patient and employee satisfaction.
Clinics across the country have begun to move to this system, commonly reducing their wait for routine appointments from 55 days to under a week. The model increases patient satisfaction not only by reducing tremendous delays but by decreasing the amount of time spent on the phone making an appointment, increasing the possibility that the patients see their own physicians, and treating the patient as an important priority for the practice.
Patient-focused access reduces cost as well. Patients seen by their own primary care doctors record fewer visits per year, are happier patients, and reduce the amount of time on the phone with support staff which opens up opportunities for more productive work.
At Dartmouth-Hitchcock, several clinical practices have explored patient-focused access. Nurse managers at the Hitchcock Clinic in Lebanon, NH, took an interest in improving access to care. The administration and clinical practice committee supported their efforts by creating access improvement teams in each practice section. The goal is to track and measure improvement over time to patient access to care.
In February, a letter was sent to all members of the section access teams. The letter outlined the background of the improvement effort as well as suggestions for areas to work on and a plan for sharing the results centerwide.
Among the suggested improvement ideas were the following:
1. Reduce the number of visit types that are used in each section.
2. Consider instituting a formal "hold" system where a certain number of appointments are left unfilled until a defined time before the appointment date.
3. Minimize unnecessary return visits.
4. Consider calling patients two to three days prior to new patient work-ups or consults to be sure they are planning on keeping the appointments.
5. Identify the top patient diagnoses that are seen in the office and develop protocols for these patients to help optimize the use of clinicians.
6. Use the "snapshot" on a regular basis.
Nashua (NH) Internal Medicine has shown particular success in its patient focused access program with both patient satisfaction and employee satisfaction rising noticeably. Nashua displays measured improvement throughout its trend charts and continues to assess and improve its program for greater efficiency, productivity, and patient satisfaction.
(For more information, go to the Access Workbook topic in the Clinical Improvement Tools section of the Quality, Education, Management, Research Web site of the Dartmouth-Hitchcock Health System: www. healthimprov.org.)
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