MORRIS HEIGHTS HEALTH CENTERADVANCED ACCESS INITIATIVE2001/2002 Walton Avenue

“YES, WE’RE OPEN”

Ralph Belloise, Site Director

Aims and Objectives

Offer same day appointment to anyone requesting to be seen on that day

Reduce cycle time to 60 minutes Reduce no-show rate by 50% from

current rates of 40-60% down to 20-30%

Increase new visits in f/y 2002 by 20% above f/y 2001

Principles of Advanced Access and Visit Redesign employed center wide.Do today’s work today.Reduce the number of visit types and visit times

in the scheduling system.Bring the service to the patient, not the patient

to the service.Optimize resources (staff, equipment, supplies,

facilities). Match resources to demand.Plan the day. Team huddles to prep charts and

plan the visit activity.

Max-packing. Do everything possible for the patient during the visit.

High Leverage Changes

Moved to an average visit time of 20 minutes, 5/01

Implemented two visit types: access and scheduled

Implemented new templates to reflect changes ,8/01

Hired an additional Internal Medicine provider, 8/01

Saturday hours effective 1/02

Adjusted staffing pattern for parity in clinical and clerical support staff, 5/01

Restructured the clerical duties in each unit so that units functioned alike, 5/01

Mandatory re-training- job description specific

Measuring the Data

Third available appointment

Internal versus External Demand (provider driven versus patient driven)

No Show rates

No Show Rates Analysis 2001 and 2002

0

10

20

30

40

50

60

Period Ending

Perc

enta

ge

Bookhardt Fisher Sheldon Elsley Pediatrics

Bookhardt 50 45 24 27

Fisher 41 34 34

Sheldon 49 45 32 36

Elsley 45 42 34 37

Pediatrics 49 48 35 39

6/30/01 12/31/01 3/31/02 8/31/02

Dr. Bookhardt No Show Data 2001 2002

49 50

45

53 52

4043

37

27

2124 24

29

25 26

30

0

10

20

30

40

50

60

May-01 Jun-01 Jul-01 Aug-01 Sep-01 Oct-01 Nov-01 Dec-01 Jan-02 Feb-02 Mar-02 Apr-02 May-02 Jun-02 Jul-02 Aug-02

Month

No

Show

Rat

e

patients sorted out

other provider's patients

Project Timeline Adult Medicine

0

10

20

30

40

50

60

70

80

90

100

26-Feb

26-Mar

30-Apr

7-May

14-May

18-Jun

23-Jul

20-Aug

24-Sep

22-Oct

26-Nov

24-Dec

31-Dec

22-Jan

25-Feb

25-Mar

29-Apr

20-May

24-Jun

29-Jul

26-Aug

30-Sep

28-Oct

25-Nov

Week of

Da

ys

to

3rd

av

ail

Bookhardt Sheldon Fisher

appt type change

vacation

new provider access templates start

vacationvacation

Internal Versus External Demand Comparison

0

500

1000

1500

2000

2500

Month/Year

Internal External Total Int/Total

Internal 606 353 487 317 470 248 639 281 410 229

External 1527 1619 1806 1422 1209 1876 1419 1598 1019 1424

Total 2133 1972 2293 1739 1679 2124 2058 1879 1429 1653

Int/Total 28% 18% 21% 18% 28% 12% 31% 15% 29% 14%

May 01 May 02 J une 01 J une 02 J uly 01 J uly 02 Aug 01 Aug 02 Sept 01 Sept 02

Same Day Activity Rates 1/1/02 – 10/31/02

Pediatrics 40%

Adult Medicine 33%

Family Practice 27%

Ob/GYN 22%

Patient Satisfaction Surveys

Category Dec 2001 Mar 2002 Nov 2002

Ease in gettingappt.

B+ B B

Helpfulness of staff B+ B B

Wait time in waitingarea

C+ C C

Wait time in examroom

B B B

First Visit Comparison

Year end 2001 October 2002 Projected 2002 Increase

746 646 970 30%

Cycle Time Tracking Study

Cycle time tracking was performed in October and November, 2002.

Average cycle time for the practice was 61 minutes.

THE PHYSICIAN’S PERSPECTIVE

Why Enhance Access to Care?

L. Jeannine Bookhardt-Murray, MD

ADVANCED ACCESS

FACILITATE ACCESS TO CARE

PROVIDE CONTINUITY OF CARE

FOCUS ON QUALITY OF CARE

REDUCE DISPARITIES IN CARE

CONTINUITY OF CARE Ensure each patient sees his/her own

provider 90% of the time to enhance quality of care, minimize potential medical errors, and improve patient satisfaction

Move away from the “walk-in” mentality see unscheduled visits as opportunities to provide care for hard to reach population

REDUCE DISPARITIES

Improve patient access to quality care

Improve efficiency

Match supply and demand

Design practice patterns that override

emotions and disruptions that occur

throughout the day

Design delivery of services to improve

outcomes

Quality Care

Make the visit meaningful for everyone (patient, staff, provider, community, and the organization).

Build a forgiving, yet, relentless system that is consistent enough to override anyone “having a bad day”

Ready, Set, Go

Providers actually spend more of the 20minutes with patients Providers able to routinely perform healthmaintenance aspects of care to patients withcomplex physical, social, and mental healthdisorders

ImprovementsComplete GYN exam rates increased from 80% in 2001

to 90% in 2002

Increased TB screenings, PPD placements, and readings

Routine depression screening incorporated into all annual health maintenance visits as of 10/01

Immunization rates increased from 74% to 85%