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

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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

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Publication Date:
August 1, 2004
Authors:
Pamela Gordon, Matthew Chin

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