Seeing beyond the issue of access: Using lean methodology to improve access to urgent PCP slots in an ambulatory care setting

Background: Among the uninsured and low income populations of inner cities, access to comprehensive and affordable primary care could mean the difference between an annual check-up and an Emergency Room visit. At the same time, hospital administrators in these areas are charged with maintaining continuity between a patient and his provider, encouraging scheduled appointments as opposed to walk-ins, and providing urgent access to a patient's Primary Care Provider (PCP) as needed. Methods: Metropolitan Hospital Center (MHC) employed Lean methodology to achieve measurable improvements in access to care. Through a series of rapid improvement events (RIEs), led by a multi-disciplinary team, and focusing on reducing waste, they implemented a series of reforms intended to address the issue of access. Results: A walk-in provider sees all patients requesting urgent, same-day appointments and, along with social workers, collect data to determine why patients are requesting walk-in slots as opposed to scheduling appointments. Patients are mailed postcards when they need to schedule a follow-up appointment which helps to lower the no-show rate by giving patients the opportunity to schedule appointments at their convenience as opposed to the same day they are seen and/or several months in advance. Clean-up of provider templates allowed for urgent access appointments. Conclusion: In April 2011, only one of the attending physicians had an available appointment within the next three weeks. In December 2011, 5 of the attending physicians had a total of 16 available appointments within the next three weeks. In addition, several contributors to walk-ins have been identified and addressed.