We will dramatically improve access to care for our primary care patients. Patient satisfaction will increase as office visits are more productive and provider continuity is improved. We will begin with our medicine practice and achieve the following results:

• Same-day access (days to third next available appointment = 0)
• Decrease no-shows by 65 percent 
• Match daily capacity to daily demand
• Decrease office cycle time by 20 percent 
• Increase staff satisfaction by 100%
• Increase patient/provider continuity by 50%

• Days to Third Next Available Appointment
• Percentage of No-Show Appointments
• Capacity and Demand
• Office Visit Cycle Time
• Future Capacity
• Patient/Provider Continuity
• Staff Satisfaction

The team participated in the October 2004-June 2005 IHI Improving Access and Efficiency in Primary Care Breakthrough Series Collaborative and they used the Collaborative change package vigorously. They noted that the highest leverage changes for their practice were the following:

• Assigning a PCP to every patient
• Having only one appointment type (30 minutes)
• Tracking supply and demand and scheduling accordingly
• Increasing return visit intervals
• Having weekly team meetings
• Not implementing anything without testing first
• Aligning compensation with project goals

By the end of the Collaborative in June 2005:

• Achieved open access and more than half of the medicine practice physicians had a third next available appointment time of zero days
• Decreased the no-show percentage from 32 percent to 15 percent
• Decreased office cycle time from 73 minutes to 55 minutes

As of December 2005, six out of the seven medicine practice physicians had a third next available appointment time of zero days and the seventh had a third next available appointment time of one day.

The day before the Christmas weekend, they had zero no-shows in their medicine practice!

The last no-show data point for the medicine practice is at 12 percent (November 2005) and their cycle time has continued down two minutes to 53 minutes (December 2005).

During the Collaborative, York set a bold goal that private physicians in their community would eventually approach them to learn more about open access, and this has indeed started to happen. Within the York Hospital Community Health Center, the impressive results of the Medicine Team have been difficult to ignore and they now plan to spread within their own clinic to the pediatric team in the spring of 2006 and the OB/GYN team in July of 2007.

Office Manager Meg Wheeler has noted that the lessons they learned from working on open access have had great applicability to other areas of their work. According to her, “Queuing theory is one of the most helpful things I have ever learned.”

03/06/2006