Improving Access

1
Improving Access

• Harry Pigman, M.D.
• Associate Chief of Staff
• VA Medical Center, New Orleans

2
Aim

• We will implement changes that will significantly
  shorten the delay patients experience in
  obtaining scheduled visits with subspecialists.
• A model approach that can be applied to all
  clinics will be developed.

3
Understand the System
4
Understand Capacity in GU

• Clinics per week
• Available appointments per clinic
• Types of GU clinics
• General urology
• Infertility clinic
• Oncology
• Staffing patterns

5
First Interventions

• Extinguish demand for ineffective care - Greater
  than 6 months for return visits
• Eliminate unnecessary visits
• Identify outdated policies
• Match capacity to demand - Abolish GU specialty
  clinics
• Eliminate unproductive periods

6
Check First Interventions
7
Understand Demand
8
Key Point Concerning Demand

• Much of our work is generated by us and is
  unnecessary

9
Next Interventions

• Extinguish ineffective care
• Identify and implement best practices for return
  visit by diagnosis
• Implement guidelines for care by diagnosis
• Hematuria
• Urinary tract infection
• Sexual dysfunction

10
Holding the Gains
11
Spread Innovation - Eye Clinic
12
Highlights of Eye Interventions

• Triage - Clinic chief review of consults before
  scheduling
• Manage the constraint - Strict eligibility
  criteria for consults
• Eliminate backlog - Review of existing
  appointments by chief

13
General Issues in Open Access

• Eliminate backlog
• Manage no shows
• Minimize walk-ins

14
Eliminate backlog

• Find unused capacity
• Keep work at the lowest level
• Eliminate unnecessary work
• Bite the bullet

15
Manage No Shows

• Structure work to accommodate missed appointments
• Client centered scheduling
• Give them a choice
• Reminders for appointments
• Shorten time to appointment
• Place responsibility for appointment on client

16
Minimize walk-ins

• Improve access
• Multiple access points for forms, FAQs
• Telephone access
• Express lane model

17
Final Observation

• Industry has gone through several stages in its
  history of quality improvement
• Each stage of evolution has created an
  infrastructure for the next stage
• Government is at the beginning of the quality
  journey
• More you learn about quality improvement, the
  more successful you will be