Collaboration between Wood River
Health Services and PCMH Practice
Transformation Facilitators:
Successful Implementation of Same
Day Access
Lynda Greene, MPA, LDN
Wood River Health Services
Scott Hewitt, MA
Brown Primary Care
Transformation Initiative
Wood River Health Services PCMH
Transformation
• Community Health Center – Primary Care, Dental, Social
Service, Behavioral Health, WIC, Sliding Fees
• Achieved Level 3 NCQA PCMH 10/2013
• 63 employees, 10,000 -patients
• Long tenured high quality providers
• 7 Medical Providers: 3 Family Practice, 1 Adult Medicine, 1
Pediatrician, 2 Nurse Practitioners
• 2 Dental Providers ; 3 Dental Hygienists
• Converted to Electronic Health Record on September 2012
• Began working with the Brown Primary Care Transformation
Initiative in 7/2012 and joined RI-CSI in 10/2013
Same Day Access
• Wood River decided to overhaul same day
availability in March 2013
• Previously had some same day appointment slots
but they were not being used as such
• Wood Rivers same day access goals and purpose :
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Seeing a patient when they need to be seen
Keeping patients out of urgent care/ER
Provider satisfaction (being able to see your own patients)
Manageable workflow
Consistency
Great customer service/Improve patient care
Context for Change
Critical contextual elements for successful implementation:
Practice-wide commitment
Wood River’s PCMH Steering Committee consists of
representatives from areas of the practice.
Each committee member has equal input into all PCMH
initiatives.
Committee members act as a liaisons between the steering
committee and their respective area.
Context for Change
Critical contextual elements for successful implementation:
Engaged Leadership
Practice leadership consistently demonstrates support for and
investment in PCMH transformation and communicates its
importance to the practice
Initiative Champions
Champions such provider champion Dr. Lisa Manlove,
Operations Manager Patty Martin, and Head of Nursing Bonnie
Cooper drove the necessary changes needed for success
Collaboration with Practice Facilitators
Practice Facilitators worked with Wood River’s PCMH Steering
Committee to develop a Same Day Access Implementation Plan.
Practice facilitators discussed and reviewed concepts and
methods essential to successful implementation:
● Ensuring balanced provider panels
● Establishing start date/working through the pre-scheduling
backlog
● Measuring supply versus demand for same day appointments
● Managing same day appointment slots in the schedule
● Strategic scheduling
Same Day Access Implementation Plan
Pilot Phase: Wood River implemented a pilot phase, during
which same day availability was not advertised to patients.
The implementation plan consisted of several key elements:
Daily measuring and tracking of supply and demand
• Number request for same day/next day appointments
• Number of patients that could not be scheduled
• Number of same day patients seen by their PCP
Same Day Access Implementation Plan
Establishing a start date to begin reserving same day
appointment slots
Wood River began reserving 3 slots per day per provider in April
2013 and steadily increased the number of same day slots in the
ensuing months
• April - 3 same day appointments per day/per provider
• May - 4 same day appointments per day/per provider
• June - 5 same day appointments per day/per provider
• July - 5 same day appointments per day/per provider
• August - the number same day appointments was
determined based on supply and demand data.
Same Day Access Implementation Plan
Strategic Scheduling
Literature: Same day appointments opened in the middle of the
day makes the most sense as they are the least desirable time
for pre-booked appointments
Staggering same day and pre-booked appointments allows for
scheduling flexibility and adaptability
Same Day Access Implementation Plan
Full Implementation Phase: In August 2013, Wood River ended
the pilot period of its same day access plan and began
advertising same day access to patients, encouraging them to
call the practice before going to the urgent care or the ER, when
appropriate.
Outcomes
Wood River has developed a same day access policy that:
Maintains same day availability while minimizing unfilled appointment
slots:
• Same day appointments open before the phone room shuts down at
night
• Morning huddles are used to ensure the same days are open.
• Same day appointments are reserved for acute, sick visits until 12pm,
after which they may be used for other types of patient appointment
requests.
Is informed by data driven improvement:
• Wood River continually tracks and reviews data on same day appointment
supply and demand as well as percentage of patients seen by PCP.
Outcomes
Preserves continuity of care
• Same day appointments are scheduled with a patient’s PCP or Care
Team whenever possible
Focuses on Patient Satisfaction
• Patients are presented with all scheduling options to best meet their
needs
Outcomes
Wood River has been able to accommodate nearly all of its patients’
same day requests
Same Day Access
Outcomes
Improved Employee Satisfaction:
Despite the added burden tracking same day access, Wood
River’s phone room staff have reported higher satisfaction by
having less encounters with patients upset over not being able
to be seen when needed.
Challenges
The implementation plan evolved over time and required
many iterations
Adherence to same day access policy
Providers with “over-subscribed” patient panels
Anticipating fluctuations in same day demand
Next Steps
Wood River will modify its same day access policy so that no
patient in need of a same day appointment will be turned
away
CAHPS Score?
Resources
Mark Murray, MD, MPA
Same-Day Appointments: Exploding the Access Paradigm
http://www.aafp.org/fpm/2000/0900/p45.html
Mark Murray, MD, MPA
Answers to Your Questions about Same Day Scheduling
http://www.aafp.org/fpm/2005/0300/p59.html
http://www.aafp.org/practice-management/pcmh/patientcare.html