The Veterans Health Administration (VHA) has dramatically reduced waiting times for appointments by targeting six clinical areas for improvements in patient access. Since the program started in 1999, average system-wide waiting times for appointments have declined sharply. In primary care, for example, national waiting times for the next available appointment dropped by 53 percent, from 60.4 days to 28.2 days.

“We have turned a major ocean liner around,” says Odette Levesque, RN, NP, project coordinator for the initiative. When seeking care from the VHA, 80 percent of veterans visit one of six clinics: primary care, audiology, cardiology, eye care, orthopedics, and urology, Levesque explains. “So, we started there,” she says.

In 1999, the VHA enrolled teams from 134 sites in an IHI Collaborative to learn strategies for reducing delays and waiting times. By implementing the principles of advanced clinic access, these clinics brought their average waiting time for an appointment down by 54 percent.

This success was significant in a system with 21 Veterans Integrated Service Networks (or VISNs) and thousands of locations. But spreading this success throughout the large VHA system proved to be a significant challenge. “Each site must examine their own gap between supply and demand and redesign accordingly,” says Renee Parlier, RN, MPA, national program manager for the VHA Advanced Clinic Access Initiative. So, the VHA created a National Leadership Team, an Advanced Clinic Access Steering Committee, a network of contacts at each VISN, and a group of clinicians who agreed to serve as coaches on advanced clinic access.

While the results are beginning to speak for themselves, Levesque estimates the project is still only about 10 to 15 percent complete. “We’re pleased with the progress, but we’ve still got a long way to go,” she says.