HealthServe Community Health Center participated in IHI's Breakthrough Series Collaborative on Improving Access and Efficiency in Primary Care.

At the start of their participation in the Collaborative, HealthServe resolved to improve office efficiency, thereby increasing access to care and yielding a more meaningful and timely patient visit.

The team outlined the following specific aims and goals:

• Same-day access (decrease time to third next available appointment to 0 days)
• Decrease wait times by 50 percent
• Actively manage daily capacity to match daily demand
• Reduce no-show rate by 50 percent
• Increase continuity between patient and provider during visits to 75 percent
• Employee satisfaction rate will remain high with a score of 80 or above
• Patient satisfaction will remain high with a score of 80 or above

• Time to third next available appointment
• Waiting time
• No-show rate
• Patient/provider continuity
• Patient satisfaction

The team used the change package taught within the Collaborative, noting that that the highest leverage changes for them were:

• Establishing only two appointment types – began testing December 2004
• Equalizing supply and demand (tracking and realigning staff assignments) – began testing December 2004
• Reducing backlog – began in February 2005
• Doing today’s work today (drew a “line in the sand” February 14, 2005, regarding open access)
• Instituting contingency planning – began testing March 2005
• Decreasing no-shows with patient reminders and instituting a no-show policy – began testing March and April 2005
• Instituting a late policy – began testing April 2005
• Increasing patient and provider continuity
• Holding team huddles every morning
• Adopting the use of PDSAs for all changes within organization – began April 2005
• Holding advanced access meetings and orientations for staff – began June 2005

This team achieved open access during their time in the Collaborative.

• Days to third next available appointment decreased from 37 days to zero days
• Waiting time for appointments decreased from 67 minutes to 47 minutes
• No-show rate decreased from 22 percent to 12 percent 
• Patient/provider continuity increased from 92 percent to 99 percent 
• Patient satisfaction increased from 93 percent to 97 percent 

HealthServe embraced the Model for Improvement and began using it throughout their organization for all improvement efforts.

They now plan to test and implement open access in other departments, such as medical records.

A team of IHI content experts has reviewed this report and determined that it is a compelling example of current results from organizations working with IHI.

03/06/2006