Jan 2003 Table of Contents

IMPROVING PATIENT CARE

Open Access as an Alternative to Patient Combat



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To improve patient care and service, simply turn off your deflector shields.

Fam Pract Manag. 2003 Jan;10(1):65-66.

“Captain, there is an unidentified spacecraft approaching. We can’t decode its message.”

“Activate the deflector shields!”

“Captain, she is coming on strong – around the flank.”

“Side shields. Translate the communication now!”

“We can’t, Captain. Our encryption technology is outdated. It will take a few minutes to search the databanks.”

“More energy to the shields. Keep them out and be ready to fire!”

“Captain, the unidentified ship says, ‘Hello, Jim. Don’t you remember me? It’s Albert. Can we board and have a drink?’”

“Is that a Federation emblem? Yes! It is Albert. Shut down the shields and beam ’em aboard. Whew. That was a close one.”

Sound familiar?

No, it’s not science fiction. It’s something we in the medical community do every day. Our offices expend huge amounts of energy trying to keep patients away from their doctors. In turn, patients must use enormous amounts of energy to break through the system to receive even the simplest of services. Our systems are set up for combat, not for the development of personal relationships between doctors and patients.

Approximately two years ago, our office embarked on an initiative to shift the paradigm from combat to friendly interaction. We embraced the concept of open access, that is, we decided to offer every patient an appointment for today when they called our office seeking care.1 No deflecting. No triage. No long waits or delays in care.

Our office, part of a 140-physician multispecialty group, serves a rural community with one full-time family physician, a part-time nurse practitioner and a full-time physician assistant. I was the first to take the plunge into open access and began by working down my backlog of previously scheduled appointments, which required coming in one hour early three days a week for several months. Eventually, the backlog had disappeared, and I started doing “today’s work today,” seeing patients on the very day they called with a concern, often within two hours. The entire staff worked hard at resisting the urge to reactivate the deflector shields. Patients were no longer triaged. They were simply invited to come in for a visit.

Then, I took it one step further. I distributed business cards with my home and cell phone numbers, along with the usual office and answering service numbers, to my patients. I had achieved real open access.

Our scheduling system now follows one simple rule: We will provide any service to any patient on the day the patient calls if we can accomplish it in 15 to 20 minutes. If more time is needed, we break this rule and schedule a future appointment with the patient. If demand swells (e.g., during flu season), I simply come in early a few days per week to cover those busy times.

Results

Since we began practicing with as few barriers to care as possible, we have seen nothing but positive outcomes. Resources previously used to maintain barriers are now directed into delivering high-quality, efficient patient care and service, allowing us to achieve the following results:

  • Visit volume increased 22 percent (due in part to a decrease in no-show appointments and an increase in efficiency),

  • Charges increased 44 percent,

  • Providers’ office hours decreased by two per week,

  • Evening and Saturday hours were discontinued,

  • Patient satisfaction increased substantially (my office moved from the 9th percentile to the 58th percentile among family physician offices in the American Medical Group Association database).

In addition, after handing out my home phone number to patients, I average one to two calls per week at home. The only calls I have received after 10 p.m. have been from my patients in labor.

What I have discovered is the counterintuitive nature of open access. As I make myself more fully available to my patients, they seem to require less time from me in order to feel satisfied, which makes me more efficient and productive. Before open access, if patients had to wait a week for an appointment, they would come to their visit with a laundry list of problems, fearing they had better pack all they could into the visit while they had my attention. Now, with fewer barriers between me and my patients, they are more confident that they will be able to see me when they need me and are actually more respectful of my time.

Most important, I am again enjoying the profession I had come to see as only a job. I come home on time more often, and I receive many more thankyou cards and baked goods from grateful patients. It was scary launching into truly open access and becoming the doctor I always dreamed of being, but it is well worth the change.

An expanding experiment

Recently, I helped launch open access throughout the rest of my 140-physician multispecialty group. Changing a large organization is much different from making adjustments in a small office, but I anticipate equal success. Those who have embraced the concept have had exciting results, and I expect their continuing success will convince the others to try it as well.

In my experience, open access has proved itself to be a brilliant concept. It has improved the care and service my office provides and has allowed me to redevelop personal and caring relationships with my patients. We simply learned of a good idea; we tried it; and it worked. It could work for your practice too.

Dr. Giannone, a family physician, is medical director of Deposit Family Care Center in Deposit, N.Y., which is a clinic of United Medical Associates (UMA), a 140-physician multispecialty group. He serves on the UMA board of directors and is also a clinical assistant professor in the Department of Family Practice-Clinical Campus, State University of New York Health Science Center at Syracuse.

Conflicts of interest: none reported.

Send comments to fpmedit@aafp.org.

1. Murray M, Tantau C. Same-day appointments: exploding the access paradigm. Fam Pract Manage. September 2000:45–50.

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