Indianhead Center of Marshfield Clinic participated in the IHI/Sloan Virtual Breakthrough Series Collaborative to Improve Access in Primary Care.

Teams participating in the Collaborative worked together for fourteen months to design, test, and deploy new models of office-based practices in health care, leading to fundamentally improved performance levels — improved access, improved office flow and efficiency, and increased patient, provider, and staff satisfaction. [The Collaborative, based on IHI's original Breakthrough Series Collaborative model, was conducted virtually, using web-based conferencing and teleconferencing in place of face-to-face meetings.]

Specific aims include the following:

• Decrease time to third next available appointment to zero days
• Decrease office visit cycle time by at least 20 percent
• Increase future capacity (open appointments) to 75 percent of total appointment slots
• Match daily demand to daily capacity (Capacity > Demand)

Outcome Measures:

Time to third next available appointment

Office visit cycle time

Future capacity

Process Measures:

Daily demand

Daily capacity

The change package to improve access and office efficiency is very lengthy and complex, and involves major changes in work flow and process. One of the strengths of the best teams is their close-to-complete use of the change package taught within the Collaborative. Marshfield Clinic — Indianhead Center began with a pilot group of five family practice physicians. The group tested and eventually implemented the entire Primary Care Access change package.

They found the following changes to be particularly high yield:

• Synchronize Patient, Provider, and Information: Start every appointment on time by asking patients to arrive 15 minutes before a scheduled appointment.
• Understand Supply and Demand: The team discovered that Monday had much more demand than supply, resulting in a change to a provider’s usual day off.
• Physician and Staff Buy-in: Set expectations, train staff on the concepts of Advanced Access, share gathered data to display positive changes for patients.
• Assign a Physician Champion: Instrumental in coaching and communicating with providers the need for change and how it will benefit them.
• Reduce the Backlog: Physicians created backlog reduction plans.
• Use future capacity chart to determine when several providers will be out of the office on a given day and create a contingency plan.
• Create and implement service agreements between primary care and specialty care offices, including Urology, ENT, Nephrology, and Orthopedics.

Marshfield Clinic—Indianhead Center achieved marked improvements in reducing delays for — and at — appointments.

• Time to third next available appointment decreased from an average of 20.3 days to an average of 1.8 days
• Percent future capacity increased from 60 percent to 74 percent
• Cycle time decreased from 47 minutes to 40 minutes
• Matching supply and demand continues to be a focus

The team tested and implemented the entire change package, the work has been sustained over time, and they plan to continue the spread to their specialty providers and other clinics within the health system.

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