Improving Access and Efficiency in the Primary Care Setting at Mountain View Medical Center
Powell Valley Healthcare—Mountain View Medical Center
Powell, Wyoming, USA
Team
Michael Tracy, MD, Physician Medical Director at Mountain View Medical Center
Betsy Spomer, MD, Family Practice and Obstetrics
Karen Coombs, Front Office Manager
Gail Piechowski, LPN, Clinic Nurse
Karen Schweigert, Receptionist
Sara Lowe, Receptionist
Aim
Our aim is to provide same-day service and access to care in the primary care outpatient clinic, with subsequent improvement in patient, staff, and provider satisfaction.
Measures
Changes
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Encouraged schedule-combing, also called schedule “scrubbing,” to identify hidden capacity on a consistent basis.
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Empowered receptionists to schedule patients, including instructing the nurses to no longer block physicians out or otherwise decrease capacity without going through the receptionists.
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Added a vacation contingency plan, allowing providers to keep up with demand upon returning from an absence. -
Implemented a quarterly clinic-wide meeting to share successes and brainstorm clinic issues including access and efficiency.
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Scheduled weekly meetings of clinic administrative staff to focus on access and efficiency issues.
Results
    
Summary of Results / Lessons Learned / Next Steps
We saw excellent improvements in access as measured by third next available appointment. However, percent open capacity is now the focus and we have yet to reach the goal of 50 percent or more consistently for most providers. We have experienced no improvement in efficiency as a clinic as measured by patient cycle time ratio for a 20-minute appointment. Those physicians who have experienced improvements have done so through starting sessions on time, real-time dictating in room with patient, and meeting with nurses and receptionists briefly at the start of each day and session.
Our no-show rate was low to begin with, and has actually increased during the course of the project. Some of this may be due to seasonal variation. Many no-shows occur when patients are scheduled with their provider for acute issues during an absence, and the problem resolves before the appointment. Deflection rate may also be a surrogate marker of the health of open access.
The ability to match demand and capacity as much as possible will be key to sustaining the changes seen in access and to improving the efficiency of the clinic. Doing this will entail working on buy-in from physicians regarding the benefits of the changes made. Need more communication, and more visible and vocal commitment from senior leaders is needed.
Contact Information
Michael Tracy, MD, Physician Clinic Director
Mountain View Medical Center
Powell, Wyoming
mtracy@pvhc.org
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