April 29, 2005

Elevate: Answering the Tough Questions

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Medical Center leadership answers the tough questions about what the elevate program is and what it means for the people who work at VUMC.

Question: Why can’t we see patients on time in the clinic?

Answer: Whenever we ask a patient to wait beyond the appointed time to see a doctor or to undergo outpatient testing, we have failed to provide good service. And it occurs all too often.

Only two circumstances come to mind that might excuse making the patient wait: the physician the patient is here to see is called into emergency surgery, or the patient needs same-day tests and consults that were unforeseeable at the time the clinic appointment was scheduled, requiring that the patient be worked in around the day’s appointments.

In a vast majority of cases, we have control over whether we see patients on time. Repeated failure to start appointments on time isn’t generally due to any lack of effort by our physicians and clinic teams. Rather, it’s due to poor work design and to a widespread but correctable knowledge deficit about how to remedy the problem.

We can fix this. It turns out that there is a science to achieving a smooth work schedule in the clinic. The first requirement is for the appointment template to match the practice style of the doctor or nurse practitioner, and for it to take into view ancillary testing and resident participation. Vanderbilt Medical Group administration is available to guide clinics to make the needed design adjustments.

Through elevate, our patient care centers are increasing their focus on service and on understanding the causes of patient dissatisfaction. We expect our PCCs to set goals and make changes, and one of the problems we look forward to seeing gone is delay of service in outpatient areas.

— Harry R. Jacobson, M.D., vice chancellor for Health Affairs