Making sense of delays in outpatient specialty care: A system perspective

Voort, Marc M B V Rouppe van der; Merode, Frits G G van; Berden, Bart

doi:10.1016/j.healthpol.2010.02.013

Cited by 20 publications

(26 citation statements)

References 7 publications

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“…A large majority of GPs see their patients without appointments, which is similar to the advanced access paradigm that is becoming increasingly popular in other countries. [3] In addition, the in-FHC waiting times for consultations are relatively short. Previous studies have shown that GP referral behaviour is very complex and difficult to explain.…”

Section: Discussionmentioning

confidence: 99%

Family practice in Turkey: Observations from a pilot implementation

Yaman

Güneş

2016

Scandinavian Journal of Primary Health Care

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ObjectiveTurkey has implemented family practice on a pilot basis as part of the reform in health care, since 2005. This paper aims to understand and describe the prevalent practice patterns and clinic characteristics during the transition period.DesignA cross-sectional descriptive study design was used.SubjectsAn online survey was conducted among Turkish GPs working as primary care doctors (without vocational training) during the reform period. Clinic and GP characteristics are analysed with descriptive statistics.ResultsList size is an important factor; larger lists lead to shorter consultation time and a longer wait for patients. GPs are generally satisfied with the reform.ConclusionDuring the transition to family practice access of patients to health care has improved and GPs are satisfied with their job. key pointsPatients in Turkey have adequate access to primary health care services.The waiting time for consultation is relatively short.Basic prevention activities occupy the majority of the GPs’ time.Reducing the panel size and introducing appointment systems may be useful.

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Section: Discussionmentioning

confidence: 99%

Family practice in Turkey: Observations from a pilot implementation

Yaman

Güneş

2016

Scandinavian Journal of Primary Health Care

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“…In general, both medical staff and management felt there was insufficient focus on the patients and their individual needs. In industry terms, the organization was running mainly as a “push” system (supply driven), instead of a “pull” system (acknowledging actual demands) (2, 3). …”

Section: Drivers Of Changementioning

confidence: 99%

“…Once at the hospital, they waited on the various steps needed for their diagnosis, preoperative preparation, and surgical treatment. Meanwhile, doctors and nurses waited for patients, for each other and for infrastructure such as beds and machines to become available (3, 4). These healthcare professionals were making things work by putting time and effort into activities that should not be required of them.…”

Section: Drivers Of Changementioning

confidence: 99%

The Use of Operational Excellence Principles in a University Hospital

et al. 2017

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The introduction of Operational Excellence in the Maastricht University Medical Center (MUMC+) has been the first of its kind and scale for a university hospital. The policy makers of the MUMC+ have combined different elements from various other business, management, and healthcare philosophies and frameworks into a unique mix. This paper summarizes the journey of developing this system and its most important aspects. Special attention is paid to the role of the operating rooms and the improvements that have taken place there, because of their central role in the working of the hospital. The MUMC+ is the leading tertiary healthcare center for the South-East region of The Netherlands and beyond. Regional, national, and international developments encouraged the MUMC+ to start significantly reorganizing its care processes from 2009 onward. First experiments with Lean Six Sigma and Business Modeling were combined with lessons learned from other centers around the world to form the MUMC+’s own type of Operational Excellence. At the time of writing, many improvement projects of different types have been successfully completed. Every single department in the hospital now uses Operational Excellence and design thinking in general as a method to develop new models of care. An evaluation in 2014 revealed several opportunities for improvement. A large number of projects were in progress, but 75% of all projects had not been completed, despite the first projects being initiated back in 2012. This led to a number of policy changes, mainly focusing on more intensive monitoring of projects and trying to do more improvement projects directly under the responsibility of the line manager. Focusing on patient value, continuous improvement, and the reduction of waste have proven to be very fitting principles for healthcare in general and specifically for application in a university hospital. Approaching improvement at a systems level while directly involving the people on the work floor in observing opportunities for improvement and realizing these has shown itself to be essential.

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“…However, seen from other perspectives, the inevitableness of delays in access time is not always shared. A common and frequently used perspective is the regular system perspective of access time . In this perspective, delays are explained as a mismatch between supply and demand .…”

Section: Introductionmentioning

confidence: 99%

“…With this perspective in mind, numerous publications have been written that have studied the possibilities to improve matching demand of and supply for outpatient specialist clinics . A significant number of publications focus on reducing the number of no‐shows .…”

Section: Introductionmentioning

confidence: 99%

Demand, capacity, and access of the outpatient clinic: A framework for analysis and improvement

Bussel

Voort

Wessel

et al. 2018

Evaluation Clinical Practice

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RationaleWhile theoretical frameworks for optimization of the outpatient processes are abundant, practical step‐by‐step analyses to give leads for improvement, to forecast capacity, and to support decision making are sparse.Aims and objectivesThis article demonstrates how to evaluate and optimize the triad of demand, (future) capacity, and access time of the outpatient clinic using a structured six‐step method.MethodsAll individual logistical patient data of an orthopaedic outpatient clinic of one complete year were analysed using a 6‐step method to evaluate demand, supply, and access time. Trends in the data were retrospectively analysed and evaluated for potential improvements. A model for decision making was tested. Both the analysis of the method and actual results were considered as main outcomes.ResultsMore than 25 000 appointments were analysed. The 6‐step method showed to be sufficient to result in valuable insights and leads for improvement. While the overall match between demand and capacity was considered adequate, the variability in capacity was much higher than in demand, thereby leading to delays in access time. Holidays and subsequent weeks showed to be of great influence for demand, capacity, and access time. Using the six‐step method, several unfavourable characteristics of the outpatient clinic were revealed and a better match between demand, supply, and access time could have been reached with only minor adjustments. Last, a clinic specific prediction and decision model for demand and capacity was made using the 6‐step method.ConclusionsThe 6‐step analysis can successfully be applied to redesign and improve the outpatient health care process. The results of the analysis showed that national holidays and variability in demand and capacity have a big influence on the outpatient clinic. Using the 6‐step method, practical improvements in outpatient logistics were easily found and leads for future decision making were contrived.

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Making sense of delays in outpatient specialty care: A system perspective

Cited by 20 publications

References 7 publications

Family practice in Turkey: Observations from a pilot implementation

Family practice in Turkey: Observations from a pilot implementation

The Use of Operational Excellence Principles in a University Hospital

Demand, capacity, and access of the outpatient clinic: A framework for analysis and improvement

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