Despite numerous local innovations in various elements of office-based care, many promising improvements remain unused, fragmented, isolated, and dispersed; their full potential has not yet been tapped. For example, numerous surveys and audits have documented shortcomings of practitioners in complying with well-established guidelines for the clinical aspects of care for patients with chronic disease.

Providers feel unprepared and too rushed to meet the educational, clinical, and psychological needs of chronically ill patients and their caregivers. Patients experience care that is uncoordinated, impersonal, and unsupportive, often enduring delays of several weeks for an appointment with a primary care physician or specialist, extended waits when placed on hold, repeated phone calls to obtain a test result or to have a question answered by a provider, and wait times of over an hour to see a physician for a scheduled appointment.

Better Models of Care Exist
Many innovative practitioners and local managers have made important breakthroughs in the design and performance of office-based practice subsystems as well as outpatient clinics and services over the past several decades. For example, major advances have been reported in improved communication between clinicians and patients; greater levels of self-care by patients and their families; effective use of guidelines, protocols, and evidenced-based medicine; use of office-based computerized patient records; and the development of highly effective scheduling systems.

Furthermore, many more such breakthroughs are achievable by adapting innovations from outside health care — innovations in information management, performance tracking, physical design, scheduling, communications, and so-called "lean production" — to the clinical office and outpatient settings. We believe that known innovations can be consolidated into new care delivery designs capable of fundamentally improved performance levels — better clinical outcomes, lower costs, higher satisfaction, and improved efficiency.

In an ideal office practice, clinicians and staff will be able to say: "We give patients exactly the care they want (and need) exactly when they want (and need) it." Care will be customized to individual preferences, capabilities, and learning styles, and will be coordinated among the clinicians in all health care sites.

Sample Results

By testing and implementing changes to reduce unnecessary visits, increase provider slots, and develop a registry, Iowa Health Systems (Des Moines, Iowa, USA) was able to increase patient visit cycle time to 45 minutes or more.