Williams M, Neal R D
(Yorkshire Primary Care Research Network), Centre for Research in Primary Care, University of Leeds.
Br J Gen Pract. 1998 Nov;48(436):1783-6.
Longer booking intervals between appointments in general practice are generally seen as 'a good thing', and have a strong 'evidence base' to support them. Changing to longer booking intervals is regarded as a pipe dream by many general practitioners (GPs). This paper reports the process and outcomes of a change to longer booking intervals in one practice, identifies the key elements of the change, and examines lessons learned for the practice, to help other practices to do similarly. The most important factor in bringing about change was the influence of facilitation by outside parties; first, by management consultants who identified solutions to the practice's problems, and secondly, by recruitment to a research study. Other outside influences were an awareness of the success of other practices in changing to 10-minute booking intervals, and the increasing 'evidence base' to support such change. Internal influences on the process were a desire to change as a result a perception that the practice was under-performing, and the stress associated with this. As a result of the change, the number of doctor consultations fell and the number of nurse consultations rose, fewer patients reconsulted, and marginal improvements were reported on doctor and patient satisfaction. Other practices may benefit from such change; the use of management consultants as facilitators may instigate such change.
在全科医疗中，延长预约之间的时间间隔通常被视为“一件好事”，并且有强有力的“证据基础”来支持。对许多全科医生（GP）来说，改为更长的预约间隔被视为一个遥不可及的梦想。本文报告了一家诊所改为更长预约间隔的过程和结果，确定了变革的关键要素，并审视了该诊所吸取的经验教训，以帮助其他诊所采取类似做法。促成变革的最重要因素是外部各方的推动作用；首先，是管理顾问，他们找出了解决该诊所问题的办法；其次，是参与一项研究。其他外部影响包括意识到其他诊所在改为10分钟预约间隔方面取得的成功，以及支持这种变革的“证据基础”不断增加。对这一过程的内部影响是，由于感觉到诊所表现不佳以及与之相关的压力而产生的变革愿望。变革的结果是，医生诊疗次数减少，护士诊疗次数增加，再次就诊的患者减少，并且在医生和患者满意度方面有小幅提升。其他诊所可能会从这种变革中受益；利用管理顾问作为推动者可能会促使这种变革发生。
