It's no secret that access to healthcare in the US can vary greatly, and according to a new Institute of Medicine (IOM) report, delayed access to care can have a negative impact on morbidity and mortality, patient satisfaction, healthcare utilization and organizational reputation. It can also greatly impact quality of life.
The IOM report, titled "Transforming Scheduling and Access: Getting to Now," is the result of an investigation by an expert committee that was charged with reviewing currently available information on healthcare access, scheduling and wait times in the US and making recommendations for the development, testing and implementation of related standards.
The committee found multiple causes for access delays, one of the top being that there’s no standardized approach for providing timely access to care. Other causes include incongruence between supply and demand, provider-focused scheduling, outdated workforce and care supply models, priority-based queues, care complexity, reimbursement complexity, financial restraints and geographic barriers.
After reviewing the available data, the IOM committee came up with some principles which it believes should be incorporated into all initiatives aimed at addressing scheduling and access issues:
- Matching supply with projected demand through formal, ongoing evaluation
- Immediate engagement and exploration of patient’s needs at the time of their inquiry
- Patient preference on the timing and nature of care, invited at inquiry
- Need-tailored care with reliable, acceptable alternatives to clinician visits
- Surge contingencies, or provisions for accommodating patients’ acute clinical problems or questions that cannot be addressed in a timely manner.
- Continuous assessment of changing circumstances in each care setting
The IOM committee also made 10 recommendations, four of which were geared toward leaders of healthcare delivery systems. Here's a summary of those recommendations:
- Front-line scheduling practices of primary, specialty, hospital and post-acute care appointments should be anchored in the principles listed above.
- The leadership and governing bodies at each level of healthcare delivery should demonstrate commitment to implementing these principles through visible and sustained direction, workflow and workforce adjustment, continuous monitoring and reframing of supply and demand, effective use of technology throughout care delivery and conducting pilot improvement efforts.
- Decisions involving designing and leading access assessment and reform should be informed by the participation of patients and their families.
- Care delivery sites should continuously assess and adjust the match between the demand for services and the organizational tools, personnel, and overall capacity available to meet the demand, including the use of alternate supply options such as alternate clinicians, telemedicine consults, patient portals and web-based information services and protocols.
The committee also made six recommendations geared toward national leadership. Those recommendations:
- National initiatives should be anchored in the principles listed above.
- Coordinated federal initiatives should be initiated to draw upon the leadership and resources of the multiple federal agencies that are important to the practical and reliable realization of access principles throughout the nation.
- All coordinated efforts across federal agencies should include representation from leaders of health care delivery systems, patients and families and industrial engineering.
- Measure developers and accreditors should collaborate in research and development initiatives to build understanding and action for proposing, testing and applying standards related to the access principles.
- Professional societies should work with standards and certification organizations to advance professional awareness, understanding and application of systems approaches, tools and incentives for the implementation/uptake of systems strategies to assess and improve healthcare scheduling and access.
- Public and private payers—and employers who pay for care—should be active participants in system improvement through initiatives that encourage creativity and innovation in the implementation and achievement of the access principles.