Transforming Health Care Scheduling and Access Getting to Now Committee on Optimizing Scheduling in Health Care Gary Kaplan, Marianne Hamilton Lopez, and J. Michael McGinnis, Editors THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001 NOTICE: The project that is the subject of this report was approved by the Govern­ ing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineer­ ing, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropri­ ate balance. This study was supported by Contract/Grant No. HHSP23337008 between the N ational Academy of Sciences and the Department of Veteran Affairs. Any opinions, fndings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily refect the views of the organizations or agencies that provided support for the project. International Standard Book Number 13: 978-0-309-33919-3 International Standard Book Number-10: 0-309-33919-7 Library of Congress Catalog Card Number: 2015947573 Additional copies of this report are available for sale from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu. For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu. Copyright 2015 by the National Academy of Sciences. All rights reserved. Printed in the United States of America The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent ad­ opted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin. Suggested citation: IOM (Institute of Medicine). 2015. Transforming health care scheduling and access: Getting to now. Washington, DC: The National Academies Press. “Knowing is not enough; we must apply. Willing is not enough; we must do.” —Goethe Advising the Nation. Improving Health. The National Academy of Sciences is a private, nonproft, self-perpetuating society of distinguished scholars engaged in scientifc and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Acad­ emy has a mandate that requires it to advise the federal government on scientifc and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences. 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The Insti­ tute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Victor J. Dzau is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sci­ ences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientifc and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. C. D. Mote, Jr., are chair and vice chair, respectively, of the National Research Council. www.national-academies.org COMMITTEE ON OPTIMIZING SCHEDULING IN HEALTH CARE GARY KAPLAN (Chair), Chairman and Chief Executive Offcer, Virginia Mason Health System JANA BAZZOLI, Vice President, Clinical Affairs, Cincinnati Children’s Hospital Medical Center JAMES C. BENNEYAN, Director, Healthcare Systems Engineering Institute, Northeastern University JAMES CONWAY, Adjunct Faculty, Department of Health Policy and Management, Harvard School of Public Health SUSAN DENTZER, Senior Policy Adviser, Robert Wood Johnson Foundation EVA LEE, Professor and Director, Operations Research in Medicine and Health Care, School of Industrial and Systems Engineering, Georgia Institute of Technology EUGENE LITVAK, President and Chief Executive Offcer, Institute for Healthcare Optimization MARK MURRAY, Mark Murray & Associates, LLC THOMAS NOLAN, Senior Fellow, Institute for Healthcare Improvement PETER PRONOVOST, Senior Vice President for Patient Safety & Quality, Johns Hopkins Schools of Medicine, Nursing, and Public Health RONALD M. WYATT, Medical Director, Healthcare Improvement, The Joint Commission IOM Staff MARIANNE HAMILTON LOPEZ, Study Director (from April 2015) MELINDA MORIN, Study Director (until April 2015) ELIZABETH JOHNSTON, Senior Program Assistant KATHERINE BURNS, Senior Program Assistant MINA BAKHTIAR, Senior Program Assistant LESLIE KWAN, Research Associate GURU MADHAVAN, Senior Program Offcer J. MICHAEL McGINNIS, Senior Scholar and Executive Director, IOM Roundtable on Value & Science-Driven Health Care Consultants JOE ALPER, Science writer REBECCA MORGAN, National Academies Library/Research Center ROBERT POOL, Copyeditor v Reviewers This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confdential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report: Karen S. Cook, Stanford University Julie A. Freischlag, University of California, Davis, School of Medicine Mark E. Frisse, Vanderbilt University Christine Hunter, U.S. Offce of Personnel Management Beverley H. Johnson, Institute for Patient- and Family-Centered Care Kenneth W. Kizer, University of California, Davis, School of Medicine Charles E. Phelps, University of Rochester Murray Ross, Kaiser Foundation Health Plan, Inc. Vinod K. Sahney, Northeastern University Katepalli R. Sreenivasan, New York University Alfred F. Tallia, Rutgers University Alan R. Washburn, U.S. Naval Postgraduate School vii viii REVIEWERS Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclu­ sions or recommendations nor did they see the fnal draft of the report before its release. The review of this report was overseen by Georges C. Benjamin, American Public Health Association, and Lawrence D. Brown, University of Pennsylvania. Appointed by the National Research Council and the Institute of Medicine, they were responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the fnal content of this report rests entirely with the authoring committee and the institution. Contents SUMMARY 1 1 IMPROVING HEALTH CARE SCHEDULING 7 Introduction, 7 Context: VA Phoenix Health Center Crisis, 8 Context: National Issues in Access and Wait Times, 9 Committee Charge and Approach, 12 2 ISSUES IN ACCESS, SCHEDULING, AND WAIT TIMES 17 Terms and Patterns, 17 Scheduling Practices by Setting, 20 Factors in Scheduling Delays and Variability, 24 Benchmarking in the Absence of Standards, 30 3 SYSTEMS STRATEGIES FOR CONTINUOUS IMPROVEMENT 33 Lessons from Industrial Engineering Practices, 34 Systems Strategies for Health Care Scheduling and Access, 39 Challenges and Barriers, 47 4 BUILDING FROM BEST PRACTICES 49 Experiences in Service Excellence, 49 Commonalities in Success, 71 Capacity Implications, 73 ix x CONTENTS 5 GETTING TO NOW 79 Capturing the Moment, 79 Committee Findings, 81 Committee Recommendations, 84 Accelerating Progress, 88 REFERENCES 91 APPENDIXES A Background Papers 107 Open Access or Advanced Access Scheduling, 108 Reengineering Flow Through the Primary Care Offce, 112 Reengineering Flow Through the Acute Care Delivery System, 115 Framework for Active Patient Involvement in Access and Scheduling, 118 References, 121 B IOM Workshops in Brief 123 Engineering Optimal Health Care Scheduling: Perspectives for the Nation, 124 Engineering Optimal Health Care Scheduling: Perspectives for the Veterans Health Administration, 130 C Committee Member Biographies 135