improving access harry pigman, m.d. associate chief of staff va medical center, new orleans
TRANSCRIPT
Improving Access
Harry Pigman, M.D.
Associate Chief of Staff
VA Medical Center, New Orleans
Aim
We will implement changes that will significantly shorten the delay patients experience in obtaining scheduled visits with subspecialists.
A model approach that can be applied to all clinics will be developed.
Understand the System
New Patient
Appointment Clinic Process Follow up
Discharge
Understand Capacity in GU
Clinics per week Available appointments per clinic Types of GU clinics
– General urology– Infertility clinic– Oncology
Staffing patterns
First Interventions
Extinguish demand for ineffective care - Greater than 6 months for return visits– Eliminate unnecessary visits– Identify outdated policies
Match capacity to demand - Abolish GU specialty clinics– Eliminate unproductive periods
Check First Interventions
0
50
100
150
200
W1 W2 W3 W4 W5 W6 W7
Week
Day
s to
Nex
t A
ppoi
ntm
ent
Understand Demand
0
2
4
6
8
10
12A
dm
it
0 to
7
7 to
14
15-2
1
21-3
0
30-6
0
60-9
0
90-1
80
>18
0
DC
Days to Next Visit
Patients
Key Point Concerning Demand
Much of our work is generated by us and is unnecessary
Next Interventions
Extinguish ineffective care– Identify and implement best practices for return
visit by diagnosis
Implement guidelines for care by diagnosis– Hematuria– Urinary tract infection– Sexual dysfunction
Holding the Gains
Days to Next Available General Urology Appointment
30
35
40
45
50
55
60
4/21/1992 4/30/1992 5/13/1992 5/27/1992 6/5/1992 6/18/1992 7/7/1992
Spread Innovation - Eye Clinic
0
50
100
150
200
250
Highlights of Eye Interventions
Triage - Clinic chief review of consults before scheduling
Manage the constraint - Strict eligibility criteria for consults
Eliminate backlog - Review of existing appointments by chief
General Issues in Open Access
Eliminate backlog Manage no shows Minimize walk-ins
Eliminate backlog
Find unused capacity– Keep work at the lowest level
Eliminate unnecessary work Bite the bullet
Manage No Shows
Structure work to accommodate missed appointments
Client centered scheduling– Give them a choice
Reminders for appointments Shorten time to appointment Place responsibility for appointment on client
Minimize walk-ins
Improve access– Multiple access points for forms, FAQs– Telephone access– Express lane model
Final Observation
Industry has gone through several stages in its history of quality improvement
Each stage of evolution has created an infrastructure for the next stage
Government is at the beginning of the quality journey
More you learn about quality improvement, the more successful you will be