Transcript Morris Heights Health Center Performance Improvement

MORRIS HEIGHTS HEALTH CENTER
ADVANCED ACCESS INITIATIVE
2001/2002 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 2030%
 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-trainingjob 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
60
Percentage
50
40
30
20
10
0
Bookhardt
6/30/01
12/31/01
3/31/02
8/31/02
50
45
24
27
41
34
34
Fisher
Sheldon
49
45
32
36
Elsley
45
42
34
37
Pediatrics
49
48
35
39
Period Ending
Bookhardt
Fisher
Sheldon
Elsley
Pediatrics
Dr. Bookhardt No Show Data 2001 2002
60
50
49
other provider's patients
53
52
50
45
No Show Rate
40
43
40
patients sorted out
37
30
30
29
27
24
24
25
26
21
20
10
0
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
Project Timeline Adult M edicine
100
vacation
90
80
Days to 3rd avail
70
60
50
40
new provider
access templates start
30
appt type change
20
vacation
vacation
10
0
26- 26- 30Feb Mar Apr
7- 14- 18May May Jun
23Jul
20- 24- 22- 26- 24- 31- 22- 25- 25- 29Aug Sep Oct Nov Dec Dec Jan Feb Mar Apr
Week of
Bookhardt
Sheldon
Fisher
20- 24May Jun
29- 26- 30- 28Jul Aug Sep Oct
25Nov
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 getting
appt.
B+
B
B
Helpfulness of staff
B+
B
B
Wait time in waiting
area
C+
C
C
Wait time in exam
room
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 20
minutes with patients
Providers able to routinely perform health
maintenance aspects of care to patients with
complex physical, social, and mental health
disorders
Improvements
Complete 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%