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Health Services Research & Development

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2017 HSR&D/QUERI National Conference Abstract

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1082 — What Providers and Clinics Can Do to Manage Wait Time Experiences: A Longitudinal Qualitative Study

Lead/Presenter: Bich Dang, COIN - Houston
All Authors: Dang BN (VA Center for Innovations in Quality, Effectiveness and Safety ) Chu H (Baylor College of Medicine) Westbrook RA (Rice University) Giordano TP (VA Center for Innovations in Quality, Effectiveness and Safety )

Little is known about the psychology of the wait time experience -- that is, how patients think and feel about the wait time experience. This study aims to understand patients' values and preferences with respect to wait time. In addition, it aims to identify actions providers and clinics can take to enhance the perception of wait time and manage negative experiences.

We conducted over 130 hours of semi-structured interviews with patients new to an HIV clinic in Houston, Texas (21 Veterans at the Michael E. DeBakey VA Medical and 35 patients at Thomas Street Health Center). We interviewed patients three times over their first year of HIV care: before the first provider visit, again within two weeks of the first visit, and again at 6-12 months. We analyzed the interviews using directed and conventional content analysis.

Our analyses showed that actual wait time, individual factors such as the perceived value of the visit and the costs of a long wait, and clinic/provider-controlled factors influence patients' overall wait time experience. Key clinic- and provider-initiated steps to improve the wait time experience included: 1) proactively informing patients of delays to reduce uncertainty and provide a greater sense of control, 2) explicitly apologizing for delays, and 3) creating opportunities for patients to use wait time constructively or more enjoyably. Patients noted the importance of these steps in curtailing frustrations that may result from a long wait and in mitigating negative wait time experiences.

Perhaps equally, if not more important than efforts to cut down the actual wait time, are efforts to change the perception of those wait times. The wait time experience is an actionable target that is an attainable and feasible focus for practice management and process improvement.

As one of the largest health systems in the US, the VA is in a unique position to develop and apply new patient-centered strategies to improve patient care experiences and retention in care. These results highlight key steps VA providers and clinics can take to improve Veterans' wait time and overall care experiences.