When trying to improve your health care access process, you’re best to first understand your current process. The most effective way to understand is to go find out. This means watching the process as it happens and gathering the facts.
After 10+ years of studying health care access processes, we have learned what to look for. Use these questions when investigating your access process to set a strong foundation for improvement work.
1) Which client/patient group’s access process are you investigating?
2) What documentation did the patient receive when they were referred?
3) How do you find out about new clients/patients (phone, voicemail, fax, visit, electronic, etc.)?
4) Where do referrals come from?
5) Who are your most trusted referrers?
6) What volumes come from each referral source?
7) By what method do referrals arrive, for each referral source?
8) How are your referrals prioritized?
9) Where do you store received referrals?
10) Do you receive and process referrals on behalf of other agencies? If so:
Referral Forms and Ancillary Documentation
11) What form(s) are used for received referrals?
12) What information does the form show/collect?
13) How often is the form filled out incorrectly?
14) What ancillary documentation do you require from the referrer? Does it get sent consistently?
15) If the referral form or ancillary documentation is incomplete, how long is spent remedying the situation?
Patient First Contact
16) How do you first contact the patient (phone, voicemail, fax, visit, etc.)?
17) Who performs the first contact?
18) How long does the first contact last?
19) What information is gathered at the first contact?
20) What information & documentation is provided to the patient on the first contact?
21) How long was the wait since the referral (min/max/average)?
22) What is the referral backlog on average? (i.e., How many people are waiting to be contacted)?
Registration and Scheduling
23) After you make first contact with the patient, how long is the wait for their first appointment (min/max/average)?
24) What electronic system, or non-electronic method, is used to schedule patients?
25) How long does the scheduling and booking process take?
26) What electronic system, or non-electronic method, is used to register patients?
27) How long does registration take?
28) What useful statistics are available from the scheduling & registration systems/methods?
29) On average, how many patients have their first appointment with your service per day/week/month?
30) Is the first appointment to begin service, or to perform intake/assessment? If the first appointment is to provide intake/assessment, how long does the patient wait from intake/assessment to first service appointment?
31) How many patients miss their first appointment due to communication errors?
32) Do you provide feedback to the referrer regarding the appointment outcome? If so, how?
33) What are your biggest headaches with the current access process?
34) Does batching (waiting for a certain number of tasks to build up) occur at any stage in the process?
35) Write a brief description of the service provided, the number and type of people providing the service, the hours of service availability and the service capacity (e.g., maximum caseload, visits per day, etc.).
Discovery of access processes isn’t limited to these questions, but they are a good start. Follow the rabbit down the hole when you stumble on something interesting with more questions and more observation.
Once you have collected this information, make the process visual by including all of your findings on a process map, which will help to clearly communicate your observations with others. Then, you will be ready to begin a truly informed discussion about improvement.