Transcript Improving Healthcare Quality: Advanced Clinic Access in

Improving Healthcare Quality:
Advanced Clinic Access in
Mental Health
Mary Schohn, Ph.D.
April 24, 2004
Background
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Quality of healthcare is determined by the design
of the healthcare system (Berwick, 2003).
Three major gaps in the current delivery of
healthcare are: (IOM, 2001)
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Overuse of procedures that do not help people get better
Under use of procedures that can help
Misuse or errors
Roadmap to improvement
Identify gaps between current performance
and desired performance
 Seek new designs
 Involve everyone (Berwick, 2003)
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VHA/IHI Collaborative
Started in 1999
 Goals
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Reducing Delays and Wait Times by 50% in six
pilot clinics
 Redesign clinic scheduling based on model of
“open access”
 Spread across all of VHA
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Improvement in Average Next
Available Appointment
Reduction in Wait Times While
Patients Increase
Mental Health and ACA
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Director’s Performance Measure FY04
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Added three Mental Health Clinics (502, 509, 510) to the
ACA Initiative for reducing waiting times
Director’s Performance Monitors FY04
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Number of clinics with wait time greater than 45 days
includes 502,513,531,540 and 547
Number of patients waiting more than 30 days beyond
the their desired appointment date.
Percentage of appointments scheduled as “next
available” compared to the national average for the MH
Performance clinics.
No show rates
Current status
Next
Available
Stopcode Wait
502
22.4
509
24.1
510
18.3
513
8.4
516
3.5
525
34.8
530
239.7
531
20.3
538
25.2
540
18.4
547
2.9
561
5.8
562
23.9
576
26.3
# of New Total New
Appointm Appoint
ents
Wait
39,436
30.7
11,966
34.4
8,267
21.5
7,778
12
493
37.6
75
13.4
6
0
5,437
29.6
2,139
42.4
4,434
30.2
2,846
8.3
2,270
37.5
844
46.2
1,088
47.8
Percent of
Next Avialable
Seen in 30
days
78.38%
76.26%
86.78%
94.29%
97.39%
34.55%
0.00%
80.56%
82.08%
82.64%
99.12%
98.28%
80.23%
73.93%
Common Strategies Used in
Mental Health ACA in VA
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Match Supply and Demand
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Measure supply and Demand
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Define supply
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Sum of clinic slots
Based on FTEE assigned to clinic
Panel sizes
Define demand
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Sum of consults, walk-ins, calls for appointments, rebooks
Common Strategies used in
Mental Health ACA in VA
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Match Supply and Demand
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Reduce appointment types
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Review appointment types to see if efficiencies can
be gained by eliminating appointment types; eg.
Reduce/eliminate intake appointments; provider
who does initial assessment provides the ongoing
care; 30 minute appointments only; triage
appointment completes the intake appointment.
Common Strategies used in
Mental Health ACA in VA
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Match Supply and Demand
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Plan for contingencies
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Be aware of seasonal variation in demand and
supply
Plan for variations; develop time off policies to
ensure coverage; cross coverage arrangements
Common Strategies Used in
Mental Health ACA in VA
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Shape the Demand
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Work Down the Backlog
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Hire temporary staff; detail staff, use OT
Review provider schedules
Reduce other demands on providers time
temporarily
Common Strategies used in
Mental Health ACA in VA
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Shape the Demand
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Reduce the Demand
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Reduce return rate visits “what’s the value of the next
appointment?”
Increase graduation rates
Develop specialty agreements
Reduce no-show rate
Reduce automatic “rebooks” for no-shows
Increase group visits
Make the first visit count
Common Strategies Used in
Mental Health ACA in VA
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Redesign system to increase supply
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Manage the constraint
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Figure out the bottleneck in the process eg. Lack of
intake slots; drop-ins; telephone calls;
documentation time
Common Strategies Used in
Mental Health ACA in VA
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Redesign System to Increase Supply
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Optimize the care team
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Review team functions and assignments – don’t
have MDs doing work that clerks or nursing staff
can do eg. AIMS, care coordination, scheduling; use
of dictation
Redistribute case load to mid-levels
Common Strategies Used in
Mental Health ACA in VA
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Redesign System to increase supply
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Predict and anticipate patient/system needs at
time of appointment
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Max packing- ensure clinical reminders are done at
time of visit
Depression follow-up preset orders
Common Strategies Used in
Mental Health ACA in VA
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Redesign System to Increase Supply
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Synchronize patient, provider and information
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Improve consult requests
Optimize rooms and equipment
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eg. Telepsychiatry in CBOCs
Role for Psychology Leaders
Make it a priority
 Develop Teams
 Review actions
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Aims and goals
 Monthly progress report
 Plans for testing and implementing changes
 Provide for spread activities and opportunities
 Identify opinion leaders
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Role for Psychology leaders
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Empower and Support Champions
Promote the project
Publicize team achievements
Present outcomes at regional/national meetings
Convert resistance
Research outcomes
Become a Clinical Coach
Resources
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ACA Liaison to MHSHG
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MH Liasion to ACA Steering Committee
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Mary Schohn, Ph.D.
ACA website
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Robert Gresen, Ph.D.
http://vaww.vsscportal.med.va.gov/aca/
ACA MH Monthly Conference Calls
Resources
VISN MH POC
 MH ACA Mail group
 MH ACA Satellite Videoconference
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August, 2004