The Risk Solutions Magazine Spring 2015

WHATS NEXT
IN PATIENT
SAFETY

THE PATIENT
EXPERIENCE

THE PATIENT EXPERIENCE

Walk through the door of a hospital or clinic, take a seat in the

waiting room, and it wont be long before access-to-care hot spots
begin to emerge.
See that patient flipping through magazines? She arrived five
minutes early for her 9 a.m. appointment. Now its 9:20 a.m., and
no one has offered her an update about when, if ever, shell be
seen. Next, step up to the counter and listen in on a few phone
conversations. One employee is placing a frantic call to a patient
who has failed to show up for his appointment the second time
hes done so this month. On the other phone, a scheduler is telling a
woman that it will be at least six weeks until she can see one of the
doctors in the practice, and shes getting quite an earful in return.
Ready for more? Head into an examination room and observe one
of the clinics physicians handing brochures to a preop patient. His
eyes never leave his EHR tablet as he asks, Any questions? The
elderly patient, who has a limited understanding of English and a

Its easy to support the idea of

improved access to care.
But how do intentions compare
to current experiences?
by Julie Kendrick

8 / Brink / Spring 2015

fear of doctors, glances at the dense and unreadable materials. No

questions, she says quietly. The doctor nods briskly and races off to
his next patient.
Finally, as you leave the clinic, you notice a man stepping off the
crosstown bus and heading quickly toward the clinic. Thats the
person who hadnt shown up for his appointment. Hes late because
his bus was stuck in traffic, and he doesnt own a cellphone, so he
couldnt call ahead.
One clinic, one typical morning: many, many examples of issues
with access to care.
Many factors make an impact
Trish Lugtu, associate director of research at MMIC, says that the
overall concept of access to care is actually comprised of a number
of patient experience factors, from minor housekeeping issues to
complex, longterm issues.

Lack of access to care can mean an actual physical barrier, like the
absence of an acute care facility or a specialist in the town where
you live, Lugtu says. It can also be impacted by cultural barriers,
such as language comprehension or health literacy. Socioeconomic
factors impact access to care if a patient has no insurance, or cannot
pay medical bills. And the term access to care has come to include
operational issues that impact overall patient satisfaction, such
as how long a patient sat in the waiting room, or the length of time
required to schedule an appointment.
Is access to care like the weather?
It can be tempting to compare access to care to the weather
everybody complains about it, but no one can do anything to change
it. But for all its inherent complexities, progress is being made.
Jan Pankratz, senior patient safety and risk management
consultant at MMIC, points to several examples in which access

to care has been improving through hard work and unwavering

intention. One thing thats important to note is that changes dont
necessarily have to be overwhelming or costly in order to make a
big impact, she says. And if youre going to make changes, its very
important they reflect the needs of the people you serve.
Pankratz points to the example of a small primary care clinic
in Wisconsin that serves the needs of a lowincome community.
Struggling with an increasing number of patient noshows, the clinic
made the dramatic decision to eliminate scheduled appointments
for all morning clinic hours. Instead, it began to see patients on a
first come, first served basis during those hours. That one change
helped the clinic run much more smoothly, Pankratz says. And
they received very positive feedback from their patients and the
wider community.

Brink / Spring 2015 / 9

THE PATIENT EXPERIENCE

Common courtesies
Pankratz says that small changes like the one at the Wisconsin clinic
can make a huge difference in access to care. Another relatively
simple discipline is to look at the daily schedule with access to care
in mind, then plan ahead for the patients youll be seeing, she says.
For example, if youre going to be seeing a number of patients who
use wheelchairs or walkers, allow extra time for them to transfer from
waiting room to treatment room.
Such common courtesies should apply to all patients, Pankratz
adds. I hear from a number of medical offices about problems with
patients who dont show up for appointments. Often, the office
wants to terminate their relationship with the patient, but I strongly
recommend to them that the first step should be a conversation
with the patient, which can include good listening as well
as boundarysetting.
Telemedicine to the rescue?
If you cant get the patient to the doctor, why not just beam an office
visit into existence? No, its not a Star Trek rerun its the reality
of telemedicine, which is gaining popularity, especially in rural areas.
According to the American Telemedicine Association, there are 200
telemedicine networks with over 3,500 service sites in the U.S., and
more than half of all U.S. hospitals use some form of telehealth.
Pankratz points to Avera as a provider who has effectively focused
on telemedicine in rural areas. Operating in eastern South Dakota
and surrounding states, Avera has an entire building devoted to
emedicine, including emergency, urgent care, pharmacy and critical
care. It allows small hospitals to get the same services as those in
big cities, Pankratz explains.
In that same region, Sanford Health is also making strides in
the field. Their One Connect program uses interactive video
consultations and patient monitoring systems in a number of
innovative ways, says Robert S. Thompson, director of education
at MMIC. Its being used for emergencies, consultations, longterm
care, home health and community education.
Still, there are cautions. As with any rapidly growing area of health
care, along with the benefits come the risks, Thompson says, citing
privacy, relationship building, continuity of care, documentation,
technology reliability, the informed consent process and
credentialing of providers. Even with these concerns, telemedicine
is on a fast track for growth, and it will perhaps offer a hightech
solution for the very human issue of access to care.
JULIE KENDRICK
Julie Kendrick is a freelance writer in Minneapolis, Minn.

10 / Brink / Spring 2015

MMIC and UMIA

provide 24/7/365
coverage under their
policies. However,
telemedicine is a
fluid and developing
area of medicine, and
rules and regulations
regarding licensing,
privileging and
malpractice coverage
are statespecific.
We stand ready to
help you address any
malpractice coverage
concerns related
to telemedicine
or any other issue
at 952.838.6808.