Transforming ______________ Getting to Now |
Committee on Optimizing Scheduling in Health Care
Gary Kaplan, Marianne Hamilton Lopez, and J. Michael McGinnis,
Editors
INSTITUTE OF MEDICINE
OF THE NATIONAL ACADEMIES
THE NATIONAL ACADEMIES PRESS
Washington, D.C.
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 Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.
This study was supported by Contract/Grant No. HHSP23337008 between the National Academy of Sciences and the Department of Veteran Affairs. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect 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 adopted 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
INSTITUTE OF MEDICINE
OF THE NATIONAL ACADEMIES
Advising the Nation. Improving Health.
Advisers to the Nation on Science, Engineering, and Medicine
The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific 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 Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences.
The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. C. D. Mote, Jr., is president of the National Academy of Engineering.
The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute 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 Sciences 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 scientific 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.
COMMITTEE ON OPTIMIZING SCHEDULING IN HEALTH CARE
GARY KAPLAN (Chair), Chairman and Chief Executive Officer, 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 Officer, 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 Officer
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
This page intentionally left blank.
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 confidential 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. Office 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
Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations nor did they see the final 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 final content of this report rests entirely with the authoring committee and the institution.
Contents
1 IMPROVING HEALTH CARE SCHEDULING
Context: VA Phoenix Health Center Crisis
Context: National Issues in Access and Wait Times
2 ISSUES IN ACCESS, SCHEDULING, AND WAIT TIMES
Scheduling Practices by Setting
Factors in Scheduling Delays and Variability
Benchmarking in the Absence of Standards
3 SYSTEMS STRATEGIES FOR CONTINUOUS IMPROVEMENT
Lessons from Industrial Engineering Practices
Systems Strategies for Health Care Scheduling and Access
4 BUILDING FROM BEST PRACTICES
Open Access or Advanced Access Scheduling
Reengineering Flow Through the Primary Care Office
Reengineering Flow Through the Acute Care Delivery System
Framework for Active Patient Involvement in Access and Scheduling
Engineering Optimal Health Care Scheduling: Perspectives for the Nation
Engineering Optimal Health Care Scheduling: Perspectives for the Veterans Health Administration