Institute for Healthcare Improvement: BTS Collaborative: Improving Access and Efficiency in Primary Care

Overview

The Breakthrough Series is IHI’s collaborative improvement methodology to rapidly deploy major changes that produce breakthrough results in a specific clinical or operational area. Collaboratives last for approximately 10 months under the guidance of an IHI panel of experts, and are open to IMPACT and non-IMPACT member organizations.

Enrollment for this program is closed. If you are interested in receiving information for the next offering of this program, please send an email to info@ihi.org.

Click here to listen to an informational call led by the faculty of this Collaborative.

The Problem

The Solution

Patients and providers alike are tired of excessive waiting times in the primary care office. It can take weeks to get a doctor's appointment and then sometimes hours in the office waiting to be seen. We don't tolerate such delays in other industries, such as banking and retail, so why do we allow it in health care?

Waiting times are not only an annoyance; they are highly stressful for patients and their families, and highly wasteful for the practice. A long waiting list of patients seeking appointments is not indicative of a popular practice; it is a sign of an inefficient one.

Health 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.

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.

Based on proven methods and techniques for achieving rapid, breakthrough improvement, this collaborative improvement project provides primary care practices with the knowledge, tools, and support to offer patients access to care at the time and in the form they choose.

This requires that the practice continually monitors and manages its resources to match capacity with the patients’ demands for services.

Areas of Focus

Participating organizations will apply three strategies for building an access system that offers patients appointments with their primary care provider on the same day they call: shape demand, match supply and demand, and redesign their office practice systems to increase capacity.

Some of the specific changes that organizations will make in their office settings include:

Reduce the number of appointment types
Consider extending clinically appropriate return visit intervals
Maximize activity at the visit to reduce future demand
Supplement face-to-face visits with alternative methods of care, such as telephone advice and triage, email, group visits, and other service innovations
Plan for contingencies
Optimize the care team by expanding the role of nurses and non-clinician staff and reducing non-care tasks for physicians
Balance capacity and demand on a daily, weekly, and long-term basis
Synchronize patients, information, and resources within the office to "do today’s work today"
Standardize rooms and equipment

Aims

Participating organizations will implement a proven change package for achieving the following goals:

Zero days between the day a patient makes a request for an appointment and the third next available appointment for a new patient physical, routine exam, or return visit
Time spent in the office on the day of a visit is not more than 30 minutes or 1.5 times the actual time spent with a clinician
Patient satisfaction scores (satisfied or very satisfied) approach 100%
Provider and staff satisfaction scores (excellent or very good) approach 100%

Related Learning Opportunity

Creating High-Performance Teams

Jump start your group into becoming a team by attending a one-day workshop on creating effective teams, offered prior to the first Learning Sessions.