Veterans Health Administration, Fairfax, Virginia.
the George Washington University Milken Institute of Public Health, Washington, D.C.
J Healthc Manag. 2021;66(6):421-430. doi: 10.1097/JHM-D-20-00257.
Timely access to services is the gateway to patient safety and quality, and scheduling is foundational to providing access to highly reliable care. An effective and efficient scheduling strategy is dependent on an evidence-based approach that focuses on critical drivers of the scheduling system related to patient safety and quality as well as access. As part of a continuing effort to improve access, the Veterans Health Administration (VHA) completed a direct causation analysis (2015-2020) using an evidence-based framework and comprehensive measurement plan. The analysis, described here, validates access benefits realized specialty by specialty and facility by facility, identifies opportunities for improvement, and acknowledges limitations of the change from the Veterans Information Systems and Technology Architecture scheduling system to the Medical Appointment Scheduling System.This analysis of the assessments illustrates business validation structures, drivers, processes, and outcomes that can support leadership decision-making related to access. We drew our assessments of people, processes, policies, and technology from on-site interviews, over-the-shoulder observations, large-group discussions, and data from the VHA Support Service Center and facility data systems; we also mapped process steps, keystrokes, and workflow. Our assessments provided support for the VHA's decision to implement the stand-alone Cerner scheduling system at one site while continuing to implement the Cerner Millennium electronic health record platform that includes the Cerner scheduling system at other VHA sites. The VHA experience provides lessons learned for healthcare leaders who seek highly reliable efforts to improve access to care.
及时获得服务是患者安全和质量的关键，而调度是提供高度可靠护理的基础。有效的调度策略取决于基于证据的方法，该方法侧重于与患者安全和质量以及可及性相关的调度系统的关键驱动因素。作为持续努力提高可及性的一部分，退伍军人健康管理局 (VHA) 使用基于证据的框架和全面的测量计划完成了直接因果分析 (2015-2020 年)。这里描述的分析验证了专科和设施实现的可及性收益，确定了改进的机会，并承认从退伍军人信息系统和技术架构调度系统到医疗预约调度系统的变更存在局限性。对评估的分析说明了支持领导层做出与可及性相关的决策的业务验证结构、驱动因素、流程和结果。我们从现场访谈、肩并肩观察、大组讨论以及来自 VHA 支持服务中心和设施数据系统的数据中评估了人员、流程、政策和技术；我们还绘制了流程步骤、按键和工作流程。我们的评估为 VHA 做出的决定提供了支持，即在一个地点实施独立的 Cerner 调度系统，同时继续在其他 VHA 地点实施包含 Cerner 调度系统的 Cerner Millennium 电子健康记录平台。VHA 的经验为寻求高度可靠的努力以改善护理可及性的医疗保健领导者提供了经验教训。
