Using the information you\'ve learned in this course, please provide your analys
ID: 372351 • Letter: U
Question
Using the information you've learned in this course, please provide your analysis of the case. Be sure to use what you've learned about Open Access, scheduling, patient flow, and what you learn from the case. Your analysis should include the following sections, at a minimum. Please clearly mark your sections.
1. Introduction to and overview of the case
2. Major issues in the case.
3. Key issue you feel needs to be addressed first.
4. Your recommendations for change.
5. Barriers do you foresee in implementing your recommendations
The Crowded Clinic
Kate Ellis, MD, Family Physician, Charles River Medical Associates; Morana Lasic, MD, Clinical Instructor in Anesthesia, Harvard Medical School and Brigham and Women’s Hospital
The Case:
You are one of the healthcare practitioners in a community health center that provides primary care to a multi-ethnic, multi-lingual urban community. Many, but not all, of the patients live below the poverty line. Physicians and nurses see a large volume of patients with challenging medical and psychosocial issues.
Lately you have realized that the scheduling of patient visits has become something of a nightmare. Because of the high volume of patients, the wait for an appointment for routine care can be anywhere from six to eight months or more. Even acutely ill patients often wait for two to three days to see a health care provider. Out of frustration, many patients are walking in without appointments, often during lunch hour or late in the afternoon when everyone is getting ready to leave.
What makes the problem so challenging is that 20 to 40 percent of patients fail to show up for appointments on a given day. Because of this high no-show rate, every other appointment on physicians’ schedules is double-booked with the expectation that, out of the 30 to 35 scheduled patients, only 20 to 25 will actually show up. Occasionally, however, most of the patients do show up – and when a significant number of acutely ill patients also arrive, the work environment becomes unbearably chaotic for everyone. Providers become harried and more likely to make mistakes, patients wait for long periods of time in crowded waiting rooms, and the atmosphere becomes increasingly hostile as the stress level mounts.
It is clear that the quality and experience of health care for many of these patients is suffering partly because of a simple lack of access to care. And it is becoming increasingly clear also that the better-insured and English-speaking patients may be getting better access: they are more likely to get a timely appointment because they are more demanding of the system, and they are more likely to keep and show up for their appointments because of better communication. You are interested in finding a way to promote more equitable access to health care.
Explanation / Answer
The management of healthcare services should be done effectively to ensure the efficiency in healthcare services. The management and administrative staff should be able to manage the patient flow and the available physicians properly; else it will result into inadequate services and long wait hour for the patients. The case given here explains about the heavy patient rush in a hospital and the difficulties faced by healthcare workers including physicians and patients due to the higher number of patients. It explains the failure of hospital administrative mechanism in managing the patients which resulted into uncontrolled patient flow, long waits for acute patients and problems associated with communication gap.
The main issue in the case is the high patient flow that is difficult to control. Another issue is the difficulty faced by the administrative staff in scheduling patient visit and the long waiting period for patients including acute patients. One more issue is the high no show rate which makes them to provide more appointments that can be afforded in a single day. Sometimes patients show up more than expected which results into long waits and conflicts. Another major issue is the communication gap between the patients and the healthcare staff due as most of the patients does not communicate in English and the healthcare workers give more attention to better insured and English speaking clients.
I think the key issue that needs to be addresses first is the discrimination shown to the patients based on language and insurance. This kind of discrimination cannot be tolerated and the hospital should make necessary arrangements to eliminate the communication gap between the patients and workers and everyone should get equal treatment. Adequate staff should be hired with knowledge in local language and culture and they can make effective communication with the patients which is essential for managing the high flow. Other staff also should be given training on the importance of communication and equal treatment of the patients.
First I recommend addressing the communication gap as discussed above. My next recommendation is to streamline the administration process and ensure the staff performs effectively. The administrative staff should ensure that the patients show up on the allotted time. They should call them and ensure their visit on the allotted date. If the patients are not visiting they should consider providing the slot to the acute patients who is given appointment on next days. The number of patients per day should be planned as per the physician’s availability and the no show rate can be managed effectively by adopting this method which reduces the chance of long waiting hours and reduce stress in the environment which improves the quality of care. Another recommendation is to analyze the reason behind the large number of patients in the area and work with healthcare department to take adequate measures to prevent commonly seen diseases. The number of patients will come down and the hospital will be able to manage the operations effectively.
The possible barriers behind hiring staff with knowledge in local language and culture can be the shortage of local people who has enough knowledge and education to handle the role. The people are mostly below poverty line and need not have enough education. Another barrier is that community is multilingual and the hospital needs to have staff with knowledge in all these languages which is practically impossible. The barrier in ensuring the patient show rate is that the patients may not respond properly and they may communicate wrongly regarding their visit. This will not allow the hospital to utilize the slot effectively if they do not come after agreeing. The barrier I can foresee in conducting a research among the patients is the hectic work flow which may not allow the workers to do proper analysis.
Related Questions
Navigate
Integrity-first tutoring: explanations and feedback only — we do not complete graded work. Learn more.