Donna Faraone, CPHQ, Performance Improvement Coordinator
Mary Therese Hankinson, MBA, MS, RD, Public Affairs Specialist
Richard Stark, MD, Associate Chief of Staff for Ambulatory Care
Linda Darby, Program Specialist
Marvin Blumenfrucht, MD, Urologist
Robert Bender, Customer Relations Manager
Lizette Deleon, RN, Director of Clinical Services, Patient Care Service
Isabel Rellosa, MD, Chief, Gastroenterology

Identify site visit model to sustain gains made to clinic access following participation in a collaborative/educational programs and achieve additional breakthrough performance as measured by decreased waiting time for a next available appointment in a specialty clinic.

Waiting time (days) to the next available appointment.

Interdisciplinary teams from all Department of Veterans Affairs health care facilities within VISN 3 participated in a  Murray/Tantau and Associates Collaborative from June 2001 through the end of February 2002. In March of 2002, VISN 3  formed the ACA Steering Council to keep the VISN focused on access improvement using ACA strategies. Of key concern was that specialty clinics did not realize the same breakthrough improvement as did Primary Care. The VISN 3 ACA Steering Council set an expectation that waiting time for performance measure specialty clinics would be 30 days or less. Combined VISN 3 Urology was targeted as the pilot to test customized ACA strategies initiated during the collaborative and identify additional breakthrough strategies.

• Assembled a site visit team to visit urology clinics at all VISN 3 facilities to assess staffing models, urology clinic practices and identify best practices within the VISN
• Developed an ACA education program customized for urology to include an Introduction to Advanced Clinic Access Concepts and Strategies, The Impact of Computerized Templates and Service Agreements in Shaping Demand, The Role of Consult Management to Work Down the Backlog and Improve Efficiency, and KLF Data Resources in  Performance Measurement
• Incorporated urology best practices found at each site into the overall educational plan
• Held a VISN Urology Summit to educate urology clinic staff from all facilities to ACA strategies and share best practices
• Identified key changes to be implemented in urology clinics at each VISN 3 facility
• Monitored waiting time to next available appointment to see the impact of changes over time
• Held a follow-up Virtual Summit to hold teams accountable for implementing changes and share stories
• Realized 76 percent improvement in urology waiting time for next available appointment from the onset of the collaborative in June 2001 through the completion of the collaborative in February 2002 to the completion of the urology summits in September of 2003
• Achieved highest breakthrough performance through implementation of the site visit model which alone realized a 56 percent reduction in waiting time
• Sustained gains made in urology waiting time through July 2004
• Identified lessons learned over a two year improvement process with urology clinics that would be applicable and customized to other specialty clinics
• Applied lessons and strategies learned from urology clinic over two years to Gastroenterology (GI)
• Achieved 45 percent reduction in GI waiting time within the first 3 months of initiating ACA changes
• Chosen as a VHA Virtual Learning Center Best Practice Lesson, thus, making the educational module available to VHA nationwide

Results:

• Combined Urology clinic waiting time for next available appointment improved by 86 percent overall from May 2001 to September 2003.
• Sustained improvement made to access  next available appointment in urology clinics through July 2004.
• Successfully applied lessons learned from Urology to GI to realize gains in a short period of time.
• Site visit model achieved the highest waiting time reduction.

Lesson Learned:

Constant motivation, performance monitors and continued feedback to providers regarding waiting time data, consult statistics, and patient satisfaction is needed to ensure accountability and keep clinicians actively engaged in the appointment process.

Donna Faraone
Performance Improvement Coordinator
Department of Veterans Affairs New Jersey Health Care System
donna.faraone @med. va.gov

[Storyboard presentation at IHI's National Forum, December 2004]