JUNE
2003
Volume 27 •
No. 6
Policy on fax, e-mail protects privacy
New feature of Skolar provides information on antibiotic effectiveness
SHC's policy on appropriate use of restraints: what physicians need to know
Whom can you talk to? Policy provides guidance to communcation
Giants event begun by Stanford physician raises fund for organ donation
Stanford Medical Group Physician led successful push for open access
Medical staff-funded awards go to 11 nurses at Nurse Week ceremony
Stanford
Medical Group physician led
successful push for open access
In the late 1990s, several Stanford physicians and administrators realized
that the outpatient clinics had some serious problems to address: Patients
were waiting weeks, even months, to see their doctors; staff turnover
was high; and physicians were spending significant amounts of time on
non-patient-care tasks.
Among the medical center leadership, there was talk about Advanced Access, a physician-developed initiative aimed at boosting clinic efficiency and allowing all patients to have same-day appointments.
It wasn't until Paul Ford got involved, however, that the talk turned into action.
Stanford Medical Group's lead physician since 1998, Ford became the driving force behind SMG's implementation of Advanced Access. Today, he presents the model to physician groups nationally and is helping other Stanford clinics implement it.
Ford admits that Advanced Access "was a lot of hard work." But the effort was worth it, he says, citing improved patient and physician satisfaction, saner work schedules and more time devoted to patient care.
"A lot of doctors today feel things are beyond their control," Ford says. "This effort shows that doctors can learn new skills and use them to turn their practice around."
Ford's introduction to Advanced Access came in December 2000 when he attended a session on the initiative at the Institute for Healthcare Improvement's annual convention in San Francisco. The session convinced Ford that Stanford should implement the program. Under it, clinics first reduce their backlog of appointments by working extra hours. Meanwhile, clinics have to change their approach to appointment scheduling. To accommodate more patients each day, appointments are shortened to 20 minutes, but appointments are used more efficiently so quality isn't compromised.
After the IHI convention, Ford submitted a proposal to SHC's then-CEO Malinda Mitchell and associate chief of staff Joseph Hopkins, seeking support to implement Advanced Access at SMG. The proposal was approved. Ford assembled a team of physicians and staff - including himself, Hopkins and family medicine physician Nancy Morioka-Douglas - who later attended four two-day seminars run by IHI. The seminars taught attendees the skills needed to successfully implement Advanced Access at their institutions.
At Stanford, a key aspect of the initiative was eliminating a complicated triage system under which patients had to speak with multiple staff to request appointments. "You practically had to beg for an appointment," Ford recalls. "Patients were unhappy, so were doctors and staff."
When SMG began implementing Advanced Access in April 2001, some physicians balked, saying it wouldn't work. But it wasn't long before positive changes became apparent. Eliminating the screening process reduced paperwork, enabling physicians and staff to spend more time on patient care. Patient satisfaction increased and no-shows decreased.
"Our physicians and staff now feel more in control, and they can deliver the kind of patient care they want to," Ford says. A key reason for the program's success, he says, is that it was implemented by Stanford physicians and staff, not outside consultants.
Plans call for expanding Advanced Access to other Stanford clinics, starting with OB/GYN, which began implementation in September. Ford is helping coordinate that effort with clinic director Jerry Shefren.
"Paul's leadership has been critical to this initiative," Shefren said. "He's a doer. If there's a problem, he addresses it, makes a decision and acts." In his new role as SHC's vice president of ambulatory care, Shefren said projects like Advanced Access "will become increasingly important as we emphasize excellent service."
Ford originally aspired to work in basic research, not patient care. Raised in Grand Junction, Colo., he majored in chemistry at Colorado State University and worked for two years in an immunology lab at Denver's National Jewish Center for Respiratory Diseases. He meanwhile volunteered in Denver General Hospital's emergency department - an experience that proved career-changing. "It was exciting-it was like the show 'ER'," he says. "I realized I preferred working with people instead of mice."
After getting his MD at University of Colorado in 1988, Ford came to Stanford for his internal medicine residency, and has been here ever since.
