The quest for quality improvement
By Chris Hill, MD, MPH, lead clinician at VG-Hillsboro
| A major component of creating access to health care is the issue of “access” itself – the ability to seek and receive care at the time the patient chooses and from the provider of choice. VG–Hillsboro Lead Provider Chris Hill, M.D. describes his clinic’s efforts to improve access for its patients. |
Most Virginia Garcia patients live chaotic lives. They may work long hours at one or more jobs. They frequently have transportation difficulties and often are transient. While some of our patients appreciate the ability to schedule routine appointments in advance, most prefer to be seen on an as-needed basis, especially when there is an urgent problem.
Virginia Garcia–Hillsboro Clinic recently completed a one-year “Access Improvement” distance-learning collaborative led by the Institute for Healthcare Improvement (IHI). The nonprofit IHI, based in Cambridge, MA, helps accelerate change in health care by cultivating promising concepts for improving patient care and turning those ideas into action. A total of 19 health care organizations from across the country participated in the Access Improvement Collaborative.
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Stressed System
Before we participated in the collaborative, we typically opened our schedule for appointments at the beginning of each month. Patients calling for an appointment later in the month would be told to call back at the beginning of the next month. This created an overload on our phones, stressed our staff and forced patients to compete with each other for soonest-available appointments.
Patients often had to wait two to three weeks for an appointment, by which time the issue either resolved itself, resulting in a no-show, or got worse, resulting in an ER visit. Patients who did arrive at the appointed time often faced a long wait for care. The result – and this can be true in any health care setting – was unmet medical needs, unhappy patients, and overstressed staff members.
The VG–Hillsboro Clinic’s goal was to improve access to care by reducing wait times for appointments and improving the percent of patients who are able to see their chosen provider on any given day. To meet these goals we focused on improving the efficiency of our services and strengthening our team approach to healthcare.
Encouraging Results
Through the IHI collaborative we instituted an “open access” system. We now are able to accommodate most patients with a visit on the day they call, or within one to two days if their chosen provider is initially unavailable. During the collaborative our percentage of visits in which patients were able to schedule with their primary provider within three days jumped from 40 percent to consistently 70 percent or greater. The no-show rate dropped from 20 percent to 15 percent – roughly one additional patient seen per day per provider. That may not seem like much, but it adds as many as 1,000-1,300 additional patients per year!
Our team approach to healthcare has become much more focused, as well. Medical Assistants now review a patient’s chart prior to the visit to make sure any laboratory information or diagnostic studies are available ahead of time, and note any preventive services that might be due. This helps reduce wait times in the clinic for our patients, and ensures that, for example, diabetic patients get their feet checked and children receive timely immunizations.
Now that we have improved access to healthcare for VG–Hillsboro’s patients, our next steps are to apply the concepts learned in the collaborative to improving the care of our many patients with chronic conditions such as diabetes and asthma, and to continue to improve our ability to provide the services our patients need, where and when they need them.
