Volume 26 • No. 1 • JANUARY 2002
'Advanced
Access' program at two primary-care clinics cuts waiting out of doctor
visits
As flu season approaches, patients who see physicians at the Stanford Medical Group and the Stanford Family Practice can find comfort in one thought: it will be quicker to make an appointment with their primary care doctor. The two primary care clinics have implemented a system that has dramatically decreased appointment wait-time and increased patient satisfaction.
Called Advanced Access, the system replaces a process that Paul Ford, staff physician leading the change, said made patients "have to prove they're sick before they can be seen." Under the traditional system, patients called to make an appointment and were often required to speak with one or more triage nurse to establish medical need. Even if they were deemed ill enough to be seen, patients rarely were seen that day.
"Our problem was a perception of great difficulty for patients to get access to appointments in our clinics," said Joe Hopkins, director of primary care. "There was a lot of unhappiness, a lot of complaints and a high abandonment rate of phone calls," meaning people who called hung up while waiting on hold.
One clinic patient said he didn't bother calling for an appointment when he had the flu because he figured he'd be better by the time he could be seen.
While severe, Hopkins said troubles with the old system weren't insurmountable. "The problem was not an insatiable demand for visits; the problem was that people were being put through such complex algorithms of when they could be seen that it created more work and took too much time," he said.
In an effort to improve its practice at the primary care clinics, which saw more than 50,000 patients last year, Stanford joined a national consortium of medical clinics implementing Advanced Access. The consortium is led by the Institute for Healthcare Improvement and is part of a larger initiative called the Idealized Design of Clinical Office Practice project. The project was designed to create new clinical office systems that improve clinical outcomes, patient and staff satisfaction and financial performancee.
Stanford set up a team, overseen by Hopkins and Linda Cook, vice president for ambulatory care, that began "working down the backlog" last spring. For five months, physicians at the two clinics saw every patient who called for, or was waiting for, an appointment. The team next revamped policies by decreasing appointment types and simplifying rules. The majority of appointments are now held for same-day visits. Hopkins said clinic physicians begin their days with their schedules more than half open - allowing them to see their own patients on a more regular basis.
Ford said the new system has already helped meet the team's initial goals. The wait for appointments has fallen to a day or less in most cases, the call abandonment rate is only 1 percent (down from 7 percent last winter), and the patient satisfaction rate for phone calls is 78 percent. He said both patients and physicians have expressed satisfaction with the system.
"Our overarching aim was to improve access and improve the satisfaction of both physicians and staff," said Ford, adding that studies show it can take up to a year for patient satisfaction rates to reach their peak.
Other team members include Nancy Morioka-Douglas, a clinical associate professor; clinic managers Jacqueline Keeling and Jocelyn Purins; and Sandra Rozmarin, a quality manager.
Blue ribbon panel, Stanford release Nezhat findings
Stanford plan shared nationwide as a model for response to bioterrorism threatsl
Pill-sized camera tested at Stanford offers unique glimpse inside small intestines
Vice president of human resources named
'Advanced Access' program at two primary-care clinics cut waiting out of doctor visits
Patient Representative Associates play key role in Emergency Department
