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Improving Access to Specialty Care

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Background: Waits and delays plague health care systems worldwide, and wait times for most specialists exceed those for primary care practices. In office-based practices, the provider office presence is not diluted by competing indispensable activities, and the demand for service is most often for a single type, or stream, of office-based appointment demand. In the more complex specialty practices, however, the demand streams for office visits and other services compete for provider time and dilute the supply of office visits.

Seven Flow Strategies, with a Focus on the Initial Appointment: Seven strategies for reduction of delay can be applied, not only at all steps in patient flow and for all demand streams but also at all steps (for example, office visit, diagnostic procedure, surgery, follow-up) and within all specialty care types and ranges of practice. Each specialty care practice will need to discover how to use the basic principles and implement customized solutions within its own unique environment. Although it is ultimately critical to eliminate the delays in all streams of service, the focus is on the application of change strategies at the initial step between primary care and all specialty care practice types. The strategies are (1) balance supply and demand at each step in the chain, (2) work down the backlog, (3) reduce appointment types, (4) independent contingency planning for all variation, (5) reduce the demand for visits, (6) increase the supply, and (7) improve the efficiency of the office work flow.

Summary: Specialists support various, distinct demand streams that require demand/supply balance to achieve optimal system performance. If demand/supply balance exists within any stream, waits can be minimized, and the practice can choose time frames within which to balance workload.

Document Type: Research Article

Publication date: March 1, 2007

More about this publication?
  • Published monthly, The Joint Commission Journal on Quality and Patient Safety is a peer-reviewed publication dedicated to providing health professionals with the information they need to promote the quality and safety of health care. The Joint Commission Journal on Quality and Patient Safety invites original manuscripts on the development, adaptation, and/or implementation of innovative thinking, strategies, and practices in improving quality and safety in health care. Case studies, program or project reports, reports of new methodologies or new applications of methodologies, research studies on the effectiveness of improvement interventions, and commentaries on issues and practices are all considered.

    Also known as Joint Commission Journal on Quality Improvement and Joint Commission Journal on Quality and Safety
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