Increasing Access to Primary Care through Operational Redesign

Background: In response to a systemwide patient satisfaction survey, the largest municipal health care system in the US embarked upon an effort to improve patient centeredness and access to primary care. Access was measured as days waiting for an available appointment and visit cycle time. Patients waited an average of 21 days for a primary care appointment and visit cycle time averaged 119 minutes. Beginning in 2002, the system conducted team based training in more than 120 clinics to reduce wait time to 3 days or less and cycle time to 60 days or less. Methods: Eight to ten month learning collaboratives of between 4 and 17 primary care clinics were attended by multidisciplinary teams. Collaborative learning sessions provided didactic sessions as well as opportunities for strategy development and sharing of ideas and best practices across sites. Sufficient time for implementing new learning was provided between sessions. Results: Average waiting time for ‘third next appointment' was reduced to 7 days and cycle time was reduced to an average of 59 minutes. No show rates were also reduced in the process, from an average of 35 % to an average of 27%. Patients and staff expressed significantly improved satisfaction in the newly adopted processes. Conclusions: A participatory process that includes training, empowerment of staff and the adoption of changed processes can result in operational changes that improve access. Operational redesign strategies may be successfully adapted to many different types of settings.