Timely access to medical care is a key to wellness yet remains a national challenge with variability by region, specialty, and insurer. The importance of timeliness was highlighted as one of the fundamental aims for health care in the Institute of Medicine’s (IOM) 2001 report, Crossing the Quality Chasm. A more recent report from the IOM, Transforming Health Care Scheduling and Access: Getting to Now, further emphasized the goal of a patient-centric health care system where patients obtain appointments when they need them and with whom they need them.
In furthering its mission of Making Lives Better, UT Health has long worked to streamline patient access starting with its Patients First initiative several years ago. In 2016, a leadership team from UT Health toured the Emory Clinic in Atlanta to study access. This led to the formation of the Access Committee (AC)* under the direction of Dr. Ronald Stewart and more recently, a subcommittee, the Access Taskforce (ATF)**, to carry forward the recommendations of its parent committee and to accelerate operations in regard to patient access.
The overarching goals of the Committee and the Taskforce are to improve access so that 65% of new patients receive appointments with primary care within seven days and with subspecialists within fourteen days.
Early interventions of the Access Committee including Early Arrival, in which patients are instructed to arrive 15 minutes early to improve clinic flow; Fast Pass, in which patients are given opportunities via MyChart messaging to schedule appointments; and Clinic-to-Clinic (C2C) scheduling in which Primary Care schedules patients directly into selected subspecialty clinics are beginning to bear fruit. Early Arrival has assisted clinics to remain on time, and Fast Pass and C2C have seen the streamlined booking of several patients.
In addition to fostering these initiatives, the ATF has undertaken a global look at the process of Access at UT Health from a systems engineering perspective with a goal of maximizing the congruence of Demand (the volume of patients needing appointments) with Supply (the number of appointment openings) while maximizing Capacity (the efficient use of resources). Each of these aspects, demand, supply, and capacity, are requiring the development and utilization of new tools for measurement.
Among the more than 40 line-item recommendations developed to date by the ATF, those that have been implemented include a review of scheduling best practices with practice staff, daily phone huddles with all UT Health practices, a web-based access tool to determine appointment availability, Subgroup Scheduling, and the development of new graphics and modified dashboards.
In addition, small teams of practice staff members (Access Teams “A-Teams”) are beginning to examine each others’ clinics to identify those that have developed novel, exceptional workflows and processes that can benefit the entire organization.
The work of the AC and ATF have greatly benefitted from the concerted support and effort of all clinical Department Chairs, Medical Directors, Practice Managers and Practice Operations. In time, UT Health will see the day when clinic schedulers use the date given by patients when asked, When would you like to be seen? as the actual appointment date.
Daniel A. Johnson, MD
Chair, Access Taskforce
*Access Committee (AC): Deborah Conway, MD; Pamela Glasscock; Carlos Jaen, MD, PhD; Nydia Kent; Stephen R. Krauss, MD; Meeghan Lautner; Laura Monroe; Diana Morrison; Patrick Nguyen, MD; Brian Reeves, MD; and Ronald Stewart, MD (Committee Chair).
**Access Task Force (ATF): Timothy Barker; Marc F. Deschaine; Glenn Gross, MD; Pamela Glasscock; Kristen Hansman; Brandon Hartman; Jeanette Hernandez; Daniel A. Johnson, MD; Kenyatta Lee, MD; Casey Peterson; Carlos Rosende, MD, FACS; and Gorden Whiting.
