High quality healthcare delivery depends on great access to care and information. We know that promoting access into our care and services is requisite to both attaining and retaining patients in a practice. Consumers want to know that they can get care when and where they need it.
Spurred by increased demand resulting from healthcare reform measures, looming workforce shortages, and concerns about access and barriers to care, many leaders are focused on transforming the delivery of healthcare.
New measures evaluating patient access are included in the Clinician and Groups Consumer Assessment of Health Providers and Systems (CG CAHPS) and Patient Centered Medical Home certification process (shown in Table 1) and continue to push for improved access to care, often focusing efforts on same day or timely access.
Element A: Patient-Centered Appointment Access (MUST-PASS)
The practice has a written process and defined standards for providing access to appointments, and regularly assesses its performance on:
| 1. Providing same-day appointments for routine and urgent care. (CRITICAL FACTOR)
| 2. Providing routine and urgent-care appointments outside regular business hours.
| 3. Providing alternative types of clinical encounters.
| 4. Availability of appointments.
| 5. Monitoring no-show rates.
| 6. Acting on identified opportunities to improve access.
Table 1. NCQA Patient Centered Medical Home Access during office hour’s requirements
Questions from the CG CAHPS survey relating to access include:
- “When you phoned this provider's office to get an appointment for care you needed right away, how often did you get an appointment as soon as you needed”
- “When you made an appointment for a check-up or routine care with this provider, how often did you get an appointment as soon as you needed?”
To meet the challenges of patient access while maintaining high quality, patient-centered care, here are a few tips that can make a big impact:
Set objective and targeted goals that measure your strategy of success
Many healthcare organizations have learned an important lesson from other service industries and are re-adopting the premise that access and service must be designed from the customer’s perspective. For example, an emerging definition of excellent access is: “The ability of a patient to seek and receive care with the provider of choice at the time the patient chooses.” Coupled with this definition must be metrics that measure and monitor ongoing progress related to patient access. Determine which measures will be used followed by setting targets.
Communicate the strategy of access to providers and staff
Access-related strategies are not likely to be successful if they are not effectively communicated to those who must implement them: the providers and staff. To accomplish this goal, many venues are available to you to ensure the message is heard loud and clear. Utilize employee forums, Leader Development Institutes (LDIs), monthly supervisory meetings, individual rounding on providers and employees, staff meetings, daily huddles, and communication boards to name a few.
When communicating the strategy of access, start with the why. Simon Sinek, author of the book “Start with the Why,” comments that “People don't buy what you do; they buy why you do it. And what you do simply proves what you believe”. When communicating the why supporting your strategy for improved access, clearly articulate that easier access leads to better outcomes.
Train staff to communicate your strategy of access to patients
Begin offering every appointment on the day a patient calls, regardless of the reason for the visit. Consistent with the concept of doing today’s work today, a posture that seeks to provide same day access to patients is not only perceived positively, but it has been found to improve the efficiency of the office. Remember also, if patients do not want to be seen on the day they call, schedule an appointment of their choosing.
Develop Key Words for schedulers to further probe the symptoms and potential urgency of patient complaints. Simply asking the patient if they “would like to be seen today” positions scheduling as a patient centered process and one of great satisfaction to patients.
Subsequent to developing Key Words, maximize validation techniques including real time coaching to support, recognize and continuously improve the skill and competence of scheduling team members. Utilize the framework of AIDET® with specific key words or phrases that comprise the full scheduling script, including the statement, “would you like to be seen today?” When validating, listen to and observe scheduling team members using these key words and capture notes on a standardized validation form allowing for skill assessment and feedback.
The significance of this challenge and more importantly, the impact on quality of care cannot be overstated. Just this week as I was working with a healthcare organization, we learned from a patient the difficulties he is having accessing care. Having recently moved back to his home town, he called to schedule an appointment with a primary care provider and was told it would be several months before he could be seen. Within the same week, he made 2 visits to the local Emergency Department with the second visit resulting in his admission for antibiotics to treat an infection.
While healthcare organizations focus on improving access to care, creating a strategy with inclusion of goals, communication of the why supporting the strategy and communicating to patients the attitude we’ve adopted, “would you like to be seen today?” will lead to better access and health for those we serve.