The health facility selected a leader that included a medical director, practicing manager, and nurse. In coordination with the support staff, the group drafted an implementation strategy. Amongst the support staff was an open access coordinator and an assistant who provided data analysis, training, and coaching. The team followed the following steps in implementing the open access strategy.
Provision of regular response of the accessibility of the patients.
It included weekly/monthly meetings that involved reviewing the progress and planning for further or additional changes to the strategy. For example, if a patient called and made an appointment, the team is to make follow-ups on the success of the appointment by noting attributes such as, if the patient successfully accessed the his or her physician, if the patient received the necessary treatment and attention desired, and if they are satisfied with the treatment plan.
In the second step of implementing the open access plan, the team will look forward to decreasing the build up of appointment, in which practices enlarged the number of scheduled time, maximum attention to services, provision of patient appointment, followup on appointment, and any practice closed after a successful appointment. At step 2, the implementation team will look at the major features of the open access appointment in which any drawback or barrier to patient accessibility is noted. The main purpose is to make the strategy as practical as possible and let the patient have full access to the physician as possible through prior scheduled booking.
Changing provider timelines: Changing provider timeline or schedule aims at increasing the capacity of appointment in days that the hospital facility records a high appointment. On these days, the overseeing team will help adjust the timetable arrangement by ensuring the patients access the services.
Regular appointment types: Under the ordinary arrangement of the open access scheduling, appointment were arranged to within 20 minutes apart that involved both follow-up appointments or urgent cases, or alternatively, a 40-minute brief for health examinations and new pre arranged schedules.
Elimination of carve-outs: Also known us frozen appointments, these are schedules set aside for speedy access to appointments. The main purpose of having the eliminated carve-outs is to enable urgent cases to receive attention.
Reorganized arrangement of follow-up scheduling: in this case, patients were requested to make their appointments at the precise appointment instead of the arrangement at checkout. It thus allowed easy and quick response to having a chance with the physician, a situation that makes it easier for a patient to minimize time wastage of earlier scheduling or appointment.
Implementation of the remainder arrangement: A follow up is made with the patient in a situation. In case they missed the appointment, the system will make a follow-up and remind the patient of the appointment or missed schedule. Under this step of the implementation of the open access scheduling, the team ensures that all missed appointments are marked and either rescheduled or cancelled according to the patients request
Development of a contingency plan in case the provider falls ill or is on vacation, that will call upon the facility to increase the sessions amongst the providers remaining and or taking up temporary new providers. The arrangemtn is to ensure that the appointment plan goes on unhitched with patent attendance given priority despite the absence of regular providers.
Finally, under the implementation, the patients will be offered and given training on the new launched open access appointment to ease their access to treatment and their preferred physicians.
Besides training and educating the patients, the team will also educate and coach the non-appointment staff. At the same time, a real time response was offered in the arrangements and meetings to help the entire team, stakeholders, patients, and other staff members adapt to the implementation plan. Figure 1 below would offer a preview of how the first phase of the implementation plan would look like with greater emphasis paid on patient appointment with their preferred physicians.
Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2587225/figure/F1/Anticipated Outcomes
Despite occasional setbacks such as absence of a physician, cancelletion of some appointment by patients, and general lack or motivation by some support staff, the first phase of the implementation plan went on smoothly as planned. Some of the outcomes included staff satisfaction with the prearrangement and ease of handling a backlog, patient satisfaction. Although the facility did not register the ultimate objective of reducing the overtime by 80%, positive customer response set the good moods of continuing with the program albeit slowness from the support staff. Amongst the staff, 65% acknowledged that the practice was excellent with a further 20% registering no change in the general arrangement of appointment as the traditional routine arrangement. The table below shows the overall patient satisfaction, and no show rating for the open access scheduling Implementation.
Patient Satisfaction-* Pre-Intervention
N=490 Post Intervention
Practice A 31% 44%
Practice B 58% 57%
Practice C 56% 48%
Practice D 40% 57%
Practice E 42% NA
Practice F 53% NA
Staff contentment (With Appointment) (n=97) (n=81)
Practice A 13% 87%
Practice B 54% 44%
Practice C 73% 86%
Practice D 8% 26%
Practice E 8% NA
Practice F 51% NA
No Show Rating (n=50, 908) (n=114, 169)
Practice A 2% 2%
Practice B 7% 6%
Practice C 17% 18%
Practice D 17% 15%
Practice E 6% 5%
Practice F NA NA
For the responses, the following questions were asked: How long did you take to get to your scheduling today? In the past 2 months, after scheduling your appointment, did you meet the physician? The responses were ranged from very good, Excellent. Due to the challenges of implementation, the staff and survey patients were not chosen to partake in the survey.
The results thus showed mixed scales with some achievements noted, improvements undertaken on both the staff and the patients. Although the ratings and feedback varied.
Although the initial period of implementing the project will cause a lot of inconvenience to the patients and medical practitioners, it is the belief amongst the analysis team that the situation will not cause hindrance in the day to day running of the facility. However, after a period of one month, measurements will be undertaken to examine the outcomes. By use of the current ratio and gross margin profit, the management will gauge the performance of the open access financially. For example, the current rate will be calculated by working out current liabilities and current assets. I.e
Current Ratio = Current Assets (involving Equipment/Building/tools)/Current liabilities (Involving cost of training, salaries to personnel, etc.)
Client satisfaction will be measured by use of Net Promoter Score, in which the management will measure how many clients will like the open access scheduling and recommend it to other likely patients. The Net Promoter Score will be undertaken through an interview, and research surveys. Repeating the entire exercise will help in giving an average result that is then used to compile the level of satisfaction. By use of the Key performance Indicator, the management and emergency unit can be in a position to comprehend and visualize the open access arrangement. The KPI is a software that enables a business entity to manage, track, analyze, and create tracking data from several KPIs. It is a software that will enable the hospital management to enter information in a designated system for accurate data collection. For example, to analyze the open access scheduling, client details, such as frequency of appointment, payment, response, and attitude will be captured via a feedback response system and later analyzed by the KPI system. Figure A, shows a KPI measurement in which the number of patients is measured considering factors such as waiting time, status, and queue. The information can be critical in determining the response of the patients in addition to the efficiency of the system in place and the effectiveness of the state of the art equipment.
Source: https://www.klipfolio.com/resources/kpi-examples/healthcare/patient-in-erThe measurements will be compared with previous measurements taken one month before (routine appointment) and one month after the implementation of the proposed intervention (open access scheduling).
Expectations are high that the total number of patients attended to through the open access scheduling will increase in line with the improved physician response. Additionally, the time taken in handling one client will significantly reduce by over 50%. However, as the staff will be learning about how to adjust to the system, time taken on one patient may not match the 80% reduction in overtime. However, a significant amount of time will be saved in the long run, as the physicians and nurses will offer a first and quick response to patient attendance. The analysis team looks forward to implementing all the recommendations of the evaluation proposal in line with the requirements of the hospital facility.
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