Health Services Research & Development

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2006 HSR&D National Meeting Abstract


3080 — Systems Engineering Tools in Healthcare Delivery: Simulating Advanced Clinic Access Patient Recall

Author List:
Woodbridge PA (VA HSR&D Center on Implementing Evidence-based Practice, Richard L. Roudebush VA Medical Center, Indianapolis, IN)
Woodward HK (Industrial Engineering Technology, Purdue School of Engineering and Technology, IUPUI, Indianapolis, IN)
Brady TF (Purdue University North Central, Westville, IN )
Doebbeling BN (VA HSR&D Center on Implementing Evidence-based Practice, Richard L. Roudebush VA Medical Center, Indianapolis, IN)

Objectives:
Multiple authorities including IOM and NAE have recommended that systems engineering tools be used to improve healthcare delivery. To demonstrate the utility of this approach, we sought to develop a simulation of the advanced clinic access (ACA) patient recall process. VA has adopted the Institute for Healthcare Improvement (IHI) ACA model as its system for improving timeliness of care. As an ACA initiative, IHI suggests that patients not requiring immediate follow-up be placed on recall lists rather than receive future appointments. Recall lists have potential to improve patient safety (fewer patients lost to follow-up), patient centeredness (easier access), timeliness, and efficiency (fewer cancellations and no-shows). Implementing recall lists requires developing and disseminating new systems and business processes. Providers and patients perceive recall lists as a radical change in healthcare delivery. Complicating implementation at the Indianapolis VAMC is an earlier failed attempt that contributes to provider and patient skepticism. Given this sensitivity, we developed a simulation of the recall process prior to full-scale expansion. The goal was to design a recall system that meets functional requirements (e.g., 95% of calls answered by the fourth ring), anticipates problems and exceptions (e.g., no response to mailed reminder), and provides management with guidance on resource allocations (e.g., number of staff).

Methods:
Detailed flowcharts that identified all major process steps and likely exceptions were developed. The flowcharts determined data requirements. Simulations were developed using ProModel™ software. The model was used to test sensitivity to changes and errors in assumptions. The model is being tested for effectiveness during expansion of recall lists to all primary care clinics at the VAMC.

Results:
A detailed description of the model and its effectiveness as tested against implementation will be presented.

Implications:
Systems engineering tools such as simulation can be used to model complex clinical processes.

Impacts:
The IOM and NAE recommend applying systems engineering tools to improve healthcare delivery. This study reports on the use of one such tool, simulations, to effect the implementation of advanced clinic access at a large tertiary care medical center. It illustrates the utility of simulations in facilitating dissemination of innovation.