1. MORRIS HEIGHTS HEALTH CENTER ADVANCED ACCESS INITIATIVE 2001/2002 Walton Avenue “ YES, WE’RE OPEN” Ralph Belloise, Site Director

2. Aims and Objectives Offer same day appointment to anyone requesting to be seen on that day Reduce cycle time to 60 minutes Reduce no-show rate by 50% from current rates of 40-60% down to 20- 30% Increase new visits in f/y 2002 by 20% above f/y 2001

3. Principles of Advanced Access and Visit Redesign employed center wide. Do today’s work today. Reduce the number of visit types and visit times in the scheduling system. Bring the service to the patient, not the patient to the service. Optimize resources (staff, equipment, supplies, facilities). Match resources to demand. Plan the day. Team huddles to prep charts and plan the visit activity. Max-packing. Do everything possible for the patient during the visit.

4. High Leverage Changes Moved to an average visit time of 20 minutes, 5/01 Implemented two visit types: access and scheduled Implemented new templates to reflect changes,8/01 Hired an additional Internal Medicine provider, 8/01 Saturday hours effective 1/02 Adjusted staffing pattern for parity in clinical and clerical support staff, 5/01 Restructured the clerical duties in each unit so that units functioned alike, 5/01 Mandatory re-training- job description specific

5. Measuring the Data Third available appointment Internal versus External Demand (provider driven versus patient driven) No Show rates

10. Same Day Activity Rates 1/1/02 – 10/31/02 Pediatrics40% Adult Medicine33% Family Practice27% Ob/GYN22%

12. Cycle Time Tracking Study Cycle time tracking was performed in October and November, 2002. Average cycle time for the practice was 61 minutes.

13. THE PHYSICIAN’S PERSPECTIVE Why Enhance Access to Care? L. Jeannine Bookhardt-Murray, MD

14. ADVANCED ACCESS FACILITATE ACCESS TO CARE PROVIDE CONTINUITY OF CARE FOCUS ON QUALITY OF CARE REDUCE DISPARITIES IN CARE

15. CONTINUITY OF CARE Ensure each patient sees his/her own provider 90% of the time to enhance quality of care, minimize potential medical errors, and improve patient satisfaction Move away from the “walk-in” mentality see unscheduled visits as opportunities to provide care for hard to reach population

16. REDUCE DISPARITIES Improve patient access to quality care Improve efficiency Match supply and demand Design practice patterns that override emotions and disruptions that occur throughout the day Design delivery of services to improve outcomes

17. Quality Care Make the visit meaningful for everyone (patient, staff, provider, community, and the organization). Build a forgiving, yet, relentless system that is consistent enough to override anyone “having a bad day”

18. Ready, Set, Go Providers actually spend more of the 20 minutes with patients Providers able to routinely perform health maintenance aspects of care to patients with complex physical, social, and mental health disorders

19. Improvements Complete GYN exam rates increased from 80% in 2001 to 90% in 2002 Increased TB screenings, PPD placements, and readings Routine depression screening incorporated into all annual health maintenance visits as of 10/01 Immunization rates increased from 74% to 85%