Improving community primary care access is a difficult and dynamic undertaking. Realizing a need to improve appointment availability, a systematic approach based on measurement, empowerment, and interaction was developed. The model fostered exchange of information and problem solving between interdependent staff sections within a managed care system. Measuring appointments demanded but not available proved to be a credible customer-focused approach to benchmark against set goals. Changing the organizational culture to become more sensitive to changing beneficiary needs was a paramount consideration. Dependent-group t tests were performed to compare the pretreatment and posttreatment effect. The empowerment-interaction model significantly improved the availability of routine and wellness-type appointments. The availability of urgent appointments improved but not significantly; a better prospective model needs to be developed. In aggregate, appointments demanded but not available (empowerment-interaction model) were more than 10% before the treatment and less than 3% with the treatment.
A cross-sectional survey of the 1992 and 1993 graduates from Army Family Practice Residencies was done to determine their non-clinical roles and their perceived level of preparedness for these roles. Sixty-nine of the 98 questionnaires mailed (70%) were returned. The non-clinical roles were divided into command, administrative, committee (subdivided into hospital level and department/clinic level), and duties outside of the hospital (subdivided into military and administrative). Twenty-nine (42%) had commands, 58 (84%) had administrative roles, 48 (70%) had hospital committee roles, 53 (77%) had department/clinic committee roles, 54 (78%) had military roles, and 42 (61%) had administrative roles outside of the hospital or clinic. The self-reported level of preparedness, on a five point Likert scale (1 = not at all, 3 = adequately, 5 = superbly), ranged from 2.2 for command to 2.9 for administrative roles outside the hospital. Residents did not feel adequately prepared for their non-clinical roles.
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