Author Affiliations: Mark Murray & Associates, Sacramento, Calif (Dr Murray); and Institute for Healthcare Improvement, Boston, Mass (Dr Berwick).
Section Editor: Drummond Rennie, MD, Deputy
Delay of care is a persistent and undesirable feature of current health
care systems. Although delay seems to be inevitable and linked to resource
limitations, it often is neither. Rather, it is usually the result of unplanned,
irrational scheduling and resource allocation. Application of queuing theory
and principles of industrial engineering, adapted appropriately to clinical
settings, can reduce delay substantially, even in small practices, without
requiring additional resources. One model, sometimes referred to as advanced access, has increasingly been shown to reduce
waiting times in primary care. The core principle of advanced access is that
patients calling to schedule a physician visit are offered an appointment
the same day. Advanced access is not sustainable if patient demand for appointments
is permanently greater than physician capacity to offer appointments. Six
elements of advanced access are important in its application
balancing supply and demand, reducing backlog, reducing the variety
of appointment types, developing contingency plans for unusual circumstances,
working to adjust demand profiles, and increasing the availability of bottleneck
resources. Although these principles are powerful, they are counter to deeply
held beliefs and established practices in health care organizations. Adopting
these principles requires strong leadership investment and support.
Murray M, Berwick DM. Advanced Access: Reducing Waiting and Delays in Primary Care. JAMA. 2003;289(8):1035–1040. doi:10.1001/jama.289.8.1035
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