Institute for Healthcare Improvement: Innovation Community: Improving Access and Efficiency in Specialty Practices

Overview

Innovation Communities are groups of improvement-minded organizations working together and with IHI to explore new designs and novel solutions to improve care where best practices do not already exist or are not fully developed. Projects last for approximately 10 months under the guidance of an IHI panel of experts, and are open to IMPACT member organizations only.

The Problem

The Solution

It would be hard to find a person in the US who has not experienced a disappointingly long waiting time for a specialty appointment. Even with a referral from a primary care physician, patients still wait weeks or often months to see a specialist.

As a result, patients are subjected to unnecessary anxiety and sometimes a worsening of their condition, thereby complicating the care once it is provided. Delays on the day of the appointment can also cause added stress and frustration for patients, contributing to low patient satisfaction.

For the specialist, delays in being able to see patients may compromise their ability to attract new patients and can negatively impact the vitality of their practices. A long waiting time for referral appointments also contributes to additional work for the specialty office such as answering repeated calls from impatient or desperate patients or primary care providers requesting that their patients be seen sooner. This unnecessary work and aggravation absorbs resources, contributes to inefficiencies, and results in even greater delays in patient access.

Great strides have been made in primary care access, but specialty care lags behind. Specialists have a unique challenge, since there are multiple sources of demand for their services (e.g., referrals from primary care providers, self-referrals, referrals from other specialists, etc.) and the types of services provided are complex and multifaceted (e.g., procedures, treatments, etc.) and often dependent on other systems (e.g., operating rooms, diagnostic testing facilities or departments, etc.).

While some specialty practices in the US and internationally have been able to improve access by applying the principles of open or advanced access, more work is needed to identify how to best improve access and reduce delays, and to customize the changes to different types of specialty settings.

The ability of health care systems to meet the growing demand for timely access to care contributes to improved patient health and satisfaction, reduced costs, and the overall success of the organization.

Specialty care providers can rid themselves of unnecessary patient waits by predicting and managing patient demand, increasing office efficiencies, and streamlining the flow of patients between provider settings.

This Innovation Community will build upon the methods and tools that have proven to be effective in the primary care setting, and adapt and apply these to the specialty office.

Participating organizations will help test a package of changes designed for rapid, breakthrough improvement, providing specialty practices with the knowledge, tools, and support to offer patients access to care at the time and in the form they choose.

Areas of Focus

This Innovation Community will take what is known in primary care access design and test new methods that create measurable improvements in the area of specialty care access and efficiency:

Shaping demand, including building partnerships between primary care and specialty care
Matching supply and demand, including coordinating schedules for diagnostic testing and procedure units with both physician and patient schedules
Redesigning the system to build capacity, including building care teams that maximize the time and expertise of the specialist

The Community will explore how best to customize the changes needed to improve access to practices with different characteristics and needs:

Specialties where relationships with referring physicians and diagnostic testing services is especially important (e.g., CHF clinics, pulmonology, neurology)
Specialties that involve procedures (e.g., orthopedics, gastroenterology, urology)
Sites where patients routinely receive multiple services and see multiple providers during a single visit (e.g., dermatology, women’s health centers, cancer centers)

Aims

Participants will test new ideas in an effort to achieve measurable improvements in specialty practice access and efficiency:

Time between the day a patient (or a referring provider) makes a request for an appointment and the third next available appointment for a specialty office visit
Total time spent in the office or specialty center on the day of a visit
Time spent with a provider or other member of the care team on the day of the visit
Patient satisfaction
Provider and staff satisfaction

To Participate

To join an Innovation Community, you must be a member of IHI's IMPACT network and have completed at least one successful improvement project within your organization. See IMPACT Network for more details about this exciting network of organizations collaborating for results.