julie kendrick for brink magazine -- access to care

7/26/2019 Julie Kendrick for Brink Magazine -- Access to Care

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The Risk Solutions Magazine Spring 2015

WHAT’S NEXTIN PATIENTSAFETY

THE PATIENTEXPERIENCE



Walk through the door of a hospital or clinic, take a seat in the

waiting room, and it won’t be long before access-to-care “hot spots”

begin to emerge.

See that patient flipping through magazines? She arrived five

minutes early for her 9 a.m. appointment. Now it’s 9:20 a.m., andno one has offered her an update about when, if ever, she’ll be

seen. Next, step up to the counter and listen in on a few phone

conversations. One employee is placing a frantic call to a patient

who has failed to show up for his appointment — the second time

he’s done so this month. On the other phone, a scheduler is telling a

woman that it will be at least six weeks until she can see one of the

doctors in the practice, and she’s getting quite an earful in return.

Ready for more? Head into an examination room and observe one

of the clinic’s physicians handing brochures to a pre-op patient. His

eyes never leave his EHR tablet as he asks, “Any questions?” The

elderly patient, who has a limited understanding of English and a

fear of doctors, glances at the dense and unreadable materials. “No

questions,” she says quietly. The doctor nods briskly and races off to

his next patient.

Finally, as you leave the clinic, you notice a man stepping off the

crosstown bus and heading quickly toward the clinic. That’s theperson who hadn’t shown up for his appointment. He’s late because

his bus was stuck in traffic, and he doesn’t own a cellphone, so he

couldn’t call ahead.

One clinic, one typical morning: many, many examples of issues

with access to care.

Many factors make an impact

Trish Lugtu, associate director of research at MMIC, says that the

overall concept of access to care is actually comprised of a number

of patient experience factors, from minor housekeeping issues to

complex, long-term issues.

It’s easy to support the idea of

improved access to care.

But how do intentions compare

to current experiences?

by Julie Kendrick

8 / Brink / Spring 2015

THE PATIENT EXPERIENCE



“Lack of access to care can mean an actual physical barrier, like the

absence of an acute care facility or a specialist in the town where

you live,” Lugtu says. “It can also be impacted by cultural barriers,

such as language comprehension or health literacy. Socioeconomic

factors impact access to care if a patient has no insurance, or cannotpay medical bills. And the term ‘access to care’ has come to include

operational issues that impact overall patient satisfaction, such

as how long a patient sat in the waiting room, or the length of time

required to schedule an appointment.”

Is access to care like the weather?

It can be tempting to compare access to care to the weather —

everybody complains about it, but no one can do anything to change

it. But for all its inherent complexities, progress is being made.

Jan Pankratz , senior patient safety and risk management

consultant at MMIC, points to several examples in which access

to care has been improving through hard work and unwavering

intention. “One thing that’s important to note is that changes don’t

necessarily have to be overwhelming or costly in order to make a

big impact,” she says. “And if you’re going to make changes, it ’s very

important they reflect the needs of the people you serve.”Pankratz points to the example of a small primary care clinic

in Wisconsin that serves the needs of a low-income community.

Struggling with an increasing number of patient no-shows, the clinic

made the dramatic decision to eliminate scheduled appointments

for all morning clinic hours. Instead, it began to see patients on a

“first come, first served” basis during those hours. “That one change

helped the clinic run much more smoothly,” Pankratz says. “And

they received very positive feedback from their patients and the

wider community.”

Brink / Spring 2015/ 9



Common courtesies

Pankratz says that small changes like the one at the Wisconsin clinic

can make a huge difference in access to care. “Another relatively

simple discipline is to look at the daily schedule with access to care

in mind, then plan ahead for the patients you’ll be seeing,” she says.“For example, if you’re going to be seeing a number of patients who

use wheelchairs or walkers, allow extra time for them to transfer from

waiting room to treatment room.”

Such common courtesies should apply to all patients, Pankratz

adds. “I hear from a number of medical offices about problems with

patients who don’t show up for appointments. Often, the office

wants to terminate their relationship with the patient, but I strongly

recommend to them that the first step should be a conversation

with the patient, which can include good listening as well

as boundary-setting.”

Telemedicine to the rescue?

If you can’t get the patient to the doctor, why not just beam an office

visit into existence? No, it’s not a “Star Trek” rerun — it’s the reality

of telemedicine, which is gaining popularity, especially in rural areas.

According to the American Telemedicine Association, there are 200

telemedicine networks with over 3,500 service sites in the U.S., and

more than half of all U.S. hospitals use some form of telehealth.

Pankratz points to Avera as a provider who has effectively focused

on telemedicine in rural areas. Operating in eastern South Dakota

and surrounding states, Avera has an entire building devoted to

e-medicine, including emergency, urgent care, pharmacy and critical

care. “It allows small hospitals to get the same services as those in

big cities,” Pankratz explains.

In that same region, Sanford Health is also making strides in

the field. “Their One Connect program uses interactive video

consultations and patient monitoring systems in a number of

innovative ways,” says Robert S. Thompson, director of education

at MMIC. “It ’s being used for emergencies, consultations, long-term

care, home health and community education.”

Still, there are cautions. “As with any rapidly growing area of health

care, along with the benefits come the risks,” Thompson says, citing

privacy, relationship building, continuity of care, documentation,

technology reliability, the informed consent process and

credentialing of providers. Even with these concerns, telemedicine

is on a fast track for growth, and it will perhaps offer a high-tech

solution for the very human issue of access to care.

JULIE KENDRICK

Julie Kendrick is a freelance writer in Minneapolis, Minn.

THE PATIENT EXPERIENCE

MMIC and UMIA

provide 24/7/365

coverage under their

policies. However,

telemedicine is a

fluid and developing

area of medicine, and

rules and regulations

regarding licensing,

privileging and

malpractice coverage

are state-specific.

We stand ready to

help you address any

malpractice coverage

concerns related

to telemedicine

or any other issue

at 952.838.6808.

10 / Brink / Spring 2015

julie kendrick for brink magazine -- access to care

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