Overview

This paper presents case studies of learning collaboratives undertaken at four community health centers to improve the delivery of patient care. Undertaken by New York City's nonprofit Primary Care Development Corporation (PCDC), the collaboratives were guided by five overarching principles: build a high-functioning team; cultivate leadership support and involvement; track data and map the process from the patient's perspective; open lines of communication; and utilize the expertise of coaches and program leaders. Each of the four PCDC health centers made dramatic improvements in getting patients in and out of the center quickly; offering appointments with the patient's primary care provider on demand; enhancing revenue collections; and attracting and retaining patients. The authors say that sustaining the processes that were changed so that benefits continue to accrue beyond the end of the collaboratives is the primary challenge for the organizations.

This related report summarizes four case studies of hospital quality, ACHIEVING A NEW STANDARD IN PRIMARY CARE FOR LOW-INCOME POPULATIONS: CASE STUDIES OF REDESIGN AND CHANGE THROUGH A LEARNING COLLABORATIVE

Executive Summary

Case Study 2: Advanced Access Learning Collaborative at Union Health Center
This case study examines how a health center dramatically redesigned its patient visit process. Union Health Center, which has provided health care services to garment industry workers in New York City since 1914, turned to PCDC to implement its Advanced Access program. The redesign was led by experts Mark Murray, M.D. and Catherine Tantau, R.N.

Union overhauled its patient scheduling system to meet its goal: offering patient appointments on demand. The key to reducing backlog and meeting demand is to measure the third-next-available appointment time. Union patients commonly had to wait as long as 15 days before they could schedule an appointment. After the seven-monthlong redesign, patients received an appointment within one day or less, which represents a 93 percent decrease in appointment scheduling time. In addition, the patient no-show rate fell, and both staff and patient satisfaction levels increased.

Pre-Redesign	Post-Redesign
Cycle time: 123 minutes	Cycle time: 52 minutes 􀃈 58%
Pre-Advanced Access	Post-Advanced Access
Third-next-available appt.: 15 days	Third-next-available appt. : 0–1 day 􀃈 93%
No-show rate: 20%	No-show rate: 15% 􀃈 25%

Union's efforts to decrease cycle times and increase productivity through the Redesign Collaborative laid the groundwork for the next program it undertook, called an Advanced Access Collaborative. This process enabled Union to implement a scheduling system that offers patients appointments on demand.

In summary, Union implemented the five strategic principles adopted by all collaborative participants. In addition, it implemented the Advanced Access core program principle (Doing Today's Work Today), and embraced six Advanced Access principles (also known as "high-leverage changes").

Advanced Access principles:

• Do today's work today
• Work down the backlog
• Reduce appointment types and times
• Develop contingency plans
• Reduce demand for visits
• Balance supply (provider time) and demand (patient visits) daily

Citation

Achieving a New Standard in Primary Care for Low-Income Populations: Case Study 2: Advanced Access Learning, Pamela Gordon, M.A., and Matthew Chin, M.P.A., The Commonwealth Fund, August 2004