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WIHI: The Road to Team-Based Primary Care and Behavioral Health
December 4, 2014 | Primary care practices across the US are facing a number of important challenges right now; prominent among them is doing a much better job at recognizing and helping patients with behavioral health issues.
WIHI: New Staffing Models for Primary Care
October 10, 2013 | This WIHI looks at ways that primary care practices can delegate responsibilities and work as a team — one of the central needs for all primary care providers today. We also take a look at the LEAP project (Learning from Effective Ambulatory Practices) and discuss success factors that LEAP has identified thus far.
WIHI: Organizing for Health: A Story from South Carolina
November 3, 2011 | Businesses, insurance companies, local hospitals, municipal offices, professional schools, and others in Columbia, South Carolina, are working together as a community to improve the wellness of citizens and increase access to primary care.
WIHI: Disability Competent Care
June 11, 2015 | A lot of progress has been made the past several decades for people with disabilities. But, there are still barriers and biases that prevent disabled individuals from leading full lives and fully accessing health care.
WIHI: The Echo Effect of Project ECHO's Access to Specialty Care
July 9, 2015 | There’s telemedicine, and then there’s Project ECHO. What began in 2003 as a process for improving access to treatment for people in New Mexico suffering from Hepatitis C, now offers support and learning for 30 different diseases and conditions, impacting patients in some 22 states.
What Works to Improve Primary Care: Effective Strategies and Case Studies
This book includes practical tools, case studies of lessons learned from providers nationwide, and other resources for physicians, staff, and managers of office practices who are seeking sustainable improvement of primary care.
Using a Virtual Breakthrough Series Collaborative to Improve Access in Primary Care
The Institute for Healthcare Improvement pioneered the Breakthrough Series (BTS), a short-term improvement project that convenes, in three face-to-face meetings, hospital or clinic teams to make rapid, significant improvement.
Resources for Public Health Quality Improvement
A collection of resources to help public health leaders and practitioners apply quality improvement to programs and processes, with the ultimate goal of saving lives, cutting costs, and getting better results.
Health Improvement Partnership of Santa Cruz County: A Triple Aim Improvement Story
This Triple Aim improvement story examines the work of one community pursuing a regional focus to improve population health, and the backbone organization that established the Triple Aim as its guiding framework for improving health outcomes of those served by safety net clinics, with a focus on vulnerable populations — in particular, low-income childless adults, undocumented people, and young entrepreneurs — all of whom had little or no access to health care.
Redesigning Ambulatory Care: Delivering the Promise
As a result of an integrated strategy and operational improvement project, Borgess Ambulatory Care (Kalamazoo, Michigan, USA) implemented a vision of service and quality excellence that improved practice processes and throughput, enhanced care coordination capabilities, improved practice flow, and increased outpatient volume.
Improving patient access to the Veterans Health Administration's primary care and specialty clinics
Do you want to know what it’s really like to implement open access in your office practice? Read about four cases studies from a primary care clinic and three specialty clinics in the Veterans Health Administration who did it.
Third Next Available Appointment
Average length of time in days between the day a patient makes a request for an appointment with a physician and the third available appointment for a new patient physical, routine exam, or return visit exam.
Use Continuous Flow to Avoid Batching
Doing work as it occurs during the course of an office visit (e.g., doing documentation at the end of each visit) reduces the bottlenecks created by holding similar types of work to be done at a future time (batching).
Synchronize Patient, Provider, and Information
Synchronization means organizing multiple processes so that they intersect at a specific agreed upon point in time. For an office visit, having the patient in the exam room ready for the provider at the same time that the provider is ready to see the patient together with the patient record (including test results, preventive care screens, etc.) will eliminate delays and smooth the flow for both providers and patients.
Do Tasks in Parallel
Rigid sequencing of steps in a process means that a delay in any step stops the entire process. Parallel processing means that the overall process can continue even if one part is delayed.
Use Just-in-Time Processing
Performing tasks in continuous flow (or just-in-time processing) requires rapidly switching from one task to another, as opposed to batching multiple tasks to complete later, and results in improved work flow and reduced turnaround time.
Standardize Rooms, Equipment, Patient Flow, and Information Flow
In an office practice, reducing unnecessary variation in exam room layout, equipment, and supplies by using standardization means that providers and staff don’t have to waste time looking for needed items either before or during a patient visit.
Improve Workflow and Remove Waste
Improving the flow of work and eliminating waste ensures that the clinical office runs as efficiently and effectively as possible.
Move Steps in the System Closer Together
The physical distance between steps in a process adds delays, and co-locating staff that need to communicate regularly improves work flow.
Use Automation and Technology
Some technologic or electronic systems such as electronic medical records, copiers, faxes, phones, walkie-talkies, and computers can save time and improve work flow in the clinical office.
Each care team member who is involved in the flow of the patient or information adds time to the process and increases the risk of error.
Find and Remove Bottlenecks
A constraint, or bottleneck, is anything that restricts the throughput of patients into and through the clinic system. Constraints occur when the demand for a particular resource (e.g., rooms, providers, tests) or part of the system is greater than the available supply.
Predict and Anticipate Patient Needs
To ensure that patient needs are met and that patients flow smoothly through the clinic process, staff look ahead on the schedule to identify patient needs for a given day or week.
Optimize the Care Team
Optimizing the care team is critical to maximizing the supply of the clinic and improving the daily flow of work.
Decrease Demand for Appointments
Reducing the amount of demand makes it easier for the system to absorb current or future levels of demand.