Improvement Report: Iowa Health System's Improvements in Office Practices

Iowa Health System
Des Moines, Iowa, USA


Mark Barnhill, DO, Medical Director
Sal Bognanni, MHSA, Director of Clinical Performance Improvement
Gail Nielsen, BSHCA, RTR, Patient Safety Administrator
Kathy Snow, Executive Assistant to Medical Director
Mary Abrams, MD, Health Management Consultant
Sandie Anderson, APRN, Disease Management Consultant
Pat Hardy, Clinic Coordinator
Kirk Phillips, MSW, MS, Statistician
Gina Ross, Director of Project / Risk Management
Jean Sloan, BSN, Information Technology Application Manager



We will improve care for all our patients with chronic disease by making improvements in our primary care clinics that impact the six IOM dimensions of quality. By the end of the first year of the Collaborative, we will spread our changes to other chronic diseases and our improved access model to at least one of our other primary care sites.


  • Number of Days until 3rd Next Available Appointment
  • Patient Visit Cycle Time (percent of patients visits meeting goal of 45 minutes or better)
  • Average HbA1c Level



  • Added appointment slots temporarily to open up the schedule in order to make room for planned visits with diabetic patients.
  • Reduced scheduled follow-ups, combed schedule for unnecessary visits, added provider slots and a vacation contingency plan.
  • Used team "huddles" in mornings and afternoons.
  • Called diabetic patients that have not been seen in over six months to schedule follow-up appointments.
  • Developed goal-setting form for patients to write own goals and assess ability to achieve them.
  • Trained nurses on goal setting.
  • Set goals of diabetic patients has increased patient self-management focus on their condition and nursing satisfaction in the care nurses provide.
  • Made follow-up calls two weeks after goal setting to check on status.
  • Developed registry from billing/scheduling/lab databases and used registry to identify patients in need of follow-up.
  • Identified and labeled charts of diabetics.
  • Updated diabetes flowsheet and placed flowsheet on all charts.





Summary of Results / Lessons Learned / Next Steps

  • Reduced time to 3rd next available appointment from 32 days to 9 days.
  • Sixty percent of providers met or exceeded the baseline goal of 45.3 minutes for office visit cycle time.
  • Currently, 90 percent of providers meet the goal of 37.3 minutes.
  • 37 of first 46 patients were meeting the goals they set more than 50 percent of the time.
  • Calling patients prior to their visits led to an increase in patients arriving early for lab tests and brief assessment of self-care.

Contact Information

Sal Bognanni, MHSA, Director of Clinical Performance Improvement
Iowa Health System

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