Achieving a New Standard in Primary Care for Low-Income Populations: Case Study 1: Redesigning the Patient Visit

August 11, 2004

Authors: Pamela Gordon, M.A., and Matthew Chin, M.P.A.

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Overview

This paper presents case studies of learning collaboratives undertaken at four community health centers to improve the delivery of patient care. Undertaken by New York City's nonprofit Primary Care Development Corporation (PCDC), the collaboratives were guided by five overarching principles: build a high-functioning team; cultivate leadership support and involvement; track data and map the process from the patient's perspective; open lines of communication; and utilize the expertise of coaches and program leaders. Each of the four PCDC health centers made dramatic improvements in getting patients in and out of the center quickly; offering appointments with the patient's primary care provider on demand; enhancing revenue collections; and attracting and retaining patients. The authors say that sustaining the processes that were changed so that benefits continue to accrue beyond the end of the collaboratives is the primary challenge for the organizations.

This related report summarizes four case studies of hospital quality, ACHIEVING A NEW STANDARD IN PRIMARY CARE FOR LOW-INCOME POPULATIONS: CASE STUDIES OF REDESIGN AND CHANGE THROUGH A LEARNING COLLABORATIVE

Executive Summary

Case Study 1: Redesigning the Patient Visit Program at the Jerome Belson Health Center
This case study documents the rigorous six-month redesign of the patient visit process at the Jerome Belson Health Center in the Bronx. The health center is one of four full-time and three part-time centers in New York City operated by the Cerebral Palsy Association (CPA) of New York State. The center serves a developmentally disabled population, which makes the task of reducing patient cycle times even more challenging than usual.
Even so, the principles of redesign successfully transformed an overcrowded waiting room that was far from user-friendly into an environment where the patient comes first, and providers and staff are highly productive.

The Jerome Belson Health Center followed a rigorous PCDC training program as it implemented the learning collaborative model. The center benefited dramatically from these changes. It decreased its average patient cycle time (total clinic visit time) from 68 minutes to 41 minutes, a reduction of 40 percent. As clinic visits became more efficient, provider productivity rose 58 percent. Providers had been treating 2.85 patients per hour, but were able to treat 4.5 patients per hour after the redesign.

Pre-RedesignPost-Redesign
Cycle time: 68 minutesCycle time: 41 minutes 􀃈 40%
Productivity: 2.85 patients per hourProductivity: 4.5 patients per hour 􀃇 58%


The Jerome Belson Health Center followed the five strategic collaborative principles outlined above. In addition, it followed 12 principles that were specific to its Redesign Collaborative:

Twelve Redesign principles:
  • Don't move the patient
  • Eliminate needless work
  • Increase clinician support
  • Communicate directly
  • Exploit technology
  • Monitor capacity in real time
  • Get all the tools and supplies you need
  • Create broad work roles
  • Organize patient care teams
  • Start all visits on time
  • Prepare for the expected
  • Do today's work today

Citation

Achieving a New Standard in Primary Care for Low-Income Populations: Case Study 1: Redesigning the Patient Visit, Pamela Gordon, M.A., and Matthew Chin, M.P.A., The Commonwealth Fund, August 2004