November 2002 • Volume 8 • Number 11 |
A practice redesign course at the Assembly focused on ways family physicians can see how their practices measure up in terms of patient satisfaction, clinical outcomes, clinical and business efficiency, and financial health.
"These measures represent vital signs for your practice," said course leader Charles Kilo, M.D., M.P.H., an internist with GreenField Health System in Portland, Ore. "Think about your practice as a system, a microsystem. Do you know your patient population? Do you know your clinical and business processes? Do you know your outcomes?"
Kilo provided attendees with control charts and other measurement techniques. "You can't improve your practice without measuring it," he said.
He described ideal practices' key components, as defined by the Institute for Healthcare Improvement. They include easy access to care, excellent interaction with patient, reliability of care and financial vitality.
Ease of access
To help FPs measure the ease of patients' access to care, Kilo described a technique of measuring the third next available appointment, defined as the number of days it takes a new patient to get the third next available appointment time for a physical exam. Under this technique, the receptionist makes note, at the same time every day, of when the third next appointment time is available.
"Measuring the third next available appointment time provides a snapshot of patients' access to urgent and routine visits," he said. "Once you have measured access with this technique, you can work to shorten the time it takes a patient to make an appointment."
Interaction with patients
To chart patient satisfaction and the quality of the patient-physician relationship, Kilo recommended using a visit survey card. Patients can rate from excellent to poor such factors as their physician's sensitivity to their special needs or concerns, whether they got the help they needed, the amount of time they waited to get an appointment, and their recent experience in getting through to the office by phone.
The efficiency of the practice can be determined by measuring the patient visit cycle time -- the average time in minutes patients spend at an office visit. Practice staff can ask 15 patients per month to fill out a survey specifying the amount of time they sat in the waiting room, waited for their physician in a patient room and spent with their physician.
Reliability of care
Measuring the reliability of care in terms of patient outcomes involves determining the number of patients who are admitted to an emergency room or hospital for at least one overnight stay. Kilo gave the example of a patient with hypertension who is rushed to a hospital after a heart attack. Should the physician have provided this patient with better preventive care? "Collect data to guide your actions," he said.
Financial viability
Finally, the financial viability of the practice can be measured using accounting methods to determine the profit margin of the practice, defined as total medical revenues minus total operating expenses.
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Copyright © 2002 by
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