Linking customer judgments with process measures to improve access to ambulatory care

The true value of patients satisfaction emerges when findings are linked with process data to direct and measure the results of continuous improvement efforts. In late 1991 Henry Ford Medical Group, with its ambulatory care facilities, began surveying internal and external customers regarding access to care.

Creating a system diagram and defining the core steps in the primary care visit process proved instrumental in identifying access issues. Focus group research and interviews with internal and external customers led to a list of "current reality" statements, which proved useful in defining process barriers and identifying potential improvement strategies. In June 1993, at the first of a series of retreats on improving access to primary care, four physician-led subgroups were formed to address key access strategies, one of which focused on the availability of telephone triage and nursing-advice services.

Key strategies for the triage/advice subgroup focused on upgrading phone systems, identifying dedicated space for triage/advice activity, and developing consistent advice guidelines.

Once upgrading had occurred in several sites, local quality improvement teams were formed to address specific phone access issues. Data suggested that clinics could use call volume to construct appointment schedules for adequate same-day access. Tracking and trending the call volume data could permit facilities to adjust provider schedules to meet daily and seasonal fluctuations in demand.

The combination of key process and patient survey data have allowed for identification of system deficiencies and monitoring of improvement efforts.