Quick guide to improve accessibility to service: the top 5!

Pere Vivó

It will take a few months, but you’ll finally get there: your agenda will have openings every day of the week and your patients will benefit from a more structured, close and quality care. But how can one overcome organizational chaos, tension and collective waste? Let's look at the five essential rules to make your service accessible:

Top 1. Be original. Be the change!

Accepting that working with waiting lists and continually resolving contingencies is an inevitable and natural situation, is a very serious mistake, as well as that of attributing the situation solely to a lack of resources or investments. We live with variability and, therefore, in the same work centre, with similar population characteristics and conditions, the accessibility data of professionals is very different. Do we question enough why?

No one doubts that convenience and accessibility are fundamental characteristics for the proper functioning of primary care and that it’s everyone's responsibility to look for strategies and solutions that improve both dimensions. However, personal action and predisposition to change are key.

Top 2. Get everyone involved: accessibility is a team issue

Do you know what’s happening in your team? Any intervention in a team requires a previous diagnostic exercise that analyzes activity by levels in quantitative, qualitative and resolution terms. This exercise is relatively simple if we have a powerful information system.

It’s necessary to open a process of structured and proactive collective reflection aimed at objectively analyzing the situation. Questions like: "what kind of patient are we visiting?" or “what value does our intervention contribute?” They are basic for the definition of new strategies.

by Gemma Torrell

It’s technically impossible to meet the demand with an offer of weekly visits that is inferior to the user’s need. Therefore, the primary care team must analyze their weekly, monthly and annual demand by professional and accept the necessary adjustments to find the balance that an increase in the supply usually implies, in the initial phases. In some environments, it's a common proposal to reduce the agenda to contain the demand, but it’s a catastrophic decision comparable to trying to park our car in a parking space that is too small.

Top 3. Design an effective circuit to manage the demand of the day

What is an acceptable delay for you? Although it has evolved in the design of accessibility indicators, it’s usual to consider 48 hours as the reasonable waiting limit. However, the culture of immediacy that we all apply in our day-to-day life contributes to our users placing excessive expectations about immediate attention, which often leads to disappointment.

If we think about the costs for the organization and the social, family, labour or personal costs of delaying care, the immediate demand in some cases could make sense. While it’s true that a lot of the immediate demand would be unjustified, it’s also unacceptable to assume as normal an eternal waiting list, which in turn encourages the user to make inappropriate urgent demands as we pointed out in the post: "The doctor gives me three weeks. Can you send me to emergency department?"

A fundamental element is to agree on a team level which interventions can be delayed and are taxable to involve the group of health administrators for their detection and management. In some territories, this process is automated and integrated into the workstation through bookings by motives.

The other key element for the resolution of prevalent acute pathology of low complexity is the involvement of the nursing group, by their new competence role. The preparation of an intra-team training program that facilitates synergies between groups and empowers nurses dramatically improves the patient's experience.

Top 4. Make the consultation most decisive: practice max-packing and anticipation

It no longer makes sense to divide visits between ordinary and urgent. We simply talk about an appointment when the patient is before us and we must practice max-packing, a technique aimed at resolving all the health demands that the patient may present in the same care act.

Once the health problems are defined, we must set the future attention intervals by constructing a virtual calendar through the reminder and appointment systems available to the clinical stations. For example, if the patient is planning a visit to a doctor of another level of care, we must also schedule a virtual reminder to contact that patient once the visit has been made. The same could be done in the case of diagnostic tests, complementary examinations or follow-up visits of acute processes.

Therefore, max-packing and anticipation may initially consume more time, but they constitute an opportunity to address the long term health of the patient and introduce a new relationship model. A more lax scenario is also created where health education can be more accommodated and patient autonomy is encouraged, involving it in the active monitoring of their activities through our telephone follow-up or remote platforms.

Top 5. Periodically evaluate and review the model 

A strategy that comprehensively addresses a key dimension of assistance such as accessibility should be reviewed by all periodically and in a structured manner through proactive detection of incidents.

The incorporation into our daily practice of qualitative diagnostic techniques is another opportunity for the growth of professionals and teams and promotes an environment of construction and involvement of all professionals in a common purpose.

Do you want to move forward? Well, no organization does it if it’s not able to define a collective challenge or explore new formulas to take advantage of the opportunities. The road will be full of obstacles and errors, but another key factor and very indicative of the maturity of a team is to recognize the falls as a prelude to success. Therefore, do you dare to make a mistake?