Sustained improvement for specialty clinic access

Jt Comm J Qual Patient Saf. 2006 Mar;32(3):142-51. doi: 10.1016/s1553-7250(06)32019-3.


Background: Veterans Affairs New Jersey Health Care System (VA NJHCS) used the advanced clinic access (ACA) strategies and applied "facility communication model" principles to improve access to care at two medical centers and a community-based outpatient clinic. Implementation of the facility model included the integration of a performance improvement (PI) structure, use of the technology, and staff participation.

Methods: VA NJHCS participated in a Veterans Integrated Service Network (VISN 3) collaborative consisting of five network facilities from June 2001 to January 2002. Specialty clinics were to develop the capacity to schedule a specialty clinic appointment in less than 30 days. ACA strategies were as follows: reduction of appointment types, reduction of demand, development of service agreement with primary care, and standardized documentation using templates.

Results: The VA NJHCS average waiting time for a next-available urology clinic appointment decreased 85.9%, versus a 26.2% reduction in the Veterans Health Administration (VHA) national average. In June 2005, the average days waiting time for a next-available urology clinic appointment at VA NJHCS was 14.2 days, or 24.6 days (63.4%) better than the VHA average of 38.8 days.

Discussion: Waiting time reduction for urology clinic appointments at VA NJHCS is similar to results reported elsewhere using the collaborative model and ACA strategies. Yet, the added dimension of a facility model resulted in a waiting time reduction for urology clinics at VA NJHCS that exceeded the VHA national average.

MeSH terms

  • Ambulatory Care Facilities / organization & administration*
  • Ambulatory Care Facilities / standards
  • Efficiency, Organizational*
  • Health Services Accessibility / organization & administration*
  • Humans
  • Medicine*
  • New Jersey
  • Patient Satisfaction
  • Specialization*
  • Total Quality Management
  • United States
  • United States Department of Veterans Affairs
  • Urology
  • Waiting Lists