GatorAdvantage

Do you know the “double secret number?”

In July 2009, during my first week on the job, an old colleague called me about his brother, who lives in Gainesville. He was experiencing an acute flare-up of a chronic medical condition, but could not get an appointment to see one of our UF specialists for two months.

I walked over to the office of a clinician who had been at UF for decades and asked for advice. “No problem,” he said. “I will take care of it. He’ll have an appointment tomorrow.”

“How can you be so sure?” I asked.

He responded, “I have the double secret number. That’s what you need to get someone in quickly.”

Historically, not just in Gainesville but across the country, the perception has evolved that faculty (and the system) at academic health centers who are highly recognized for their expertise sometimes send a signal to patients that “You are lucky to be able to be seen at the university.” As Dr. Marvin Dewar, senior associate dean and CEO of University of Florida Physicians has commented, the signal should be the reverse: “We are truly lucky to have you as patients.”

At the very core of our Strategic Plan is the patient. Doing what’s best for the patient comes first — starting with a timely appointment and continuing through a quality visit and effective follow-up. Only if we get the patient care piece right will we be able to maximize our potential in education and research. We are privileged that our patients call for an appointment to see us, and we should do what we can to see them in a timely manner.

Timely access is a central quality goal cited in the Strategic Plan, and was reinforced by the 150+ attendees at the June quality retreat as one of the “Big Aims” of the action plan (see Aug. 6, 2010 newsletter). How can we address this Big Aim? What can we do as a game-changer for access? Answer: We can simply state that any patient who calls should be given an appointment in the time frame desired, including the next day if sought.

You might think that such an idea would be met with responses like “that’s impossible,” or perhaps “we could do something like that over time, but it would be slow because of the fundamental culture change required.” But no. The senior leadership of UF&Shands, including those who have been in the institution for many years, said “people are ready for this; now is the time.”

Dr. Dewar was charged with overseeing the effort on our Gainesville campus. Many people, including many of you, made it happen. The first task was to come up with a great name for the program, one that would appeal to providers, staff and patients: GatorAdvantage. Dr. Dewar then addressed the issue of how best to roll out GatorAdvantage. The next big question was where to begin. Start too small and GatorAdvantage might not grow to accomplish a Big Aim. Start too big and the organizational complexities might sink the effort at the outset. After discussion with hospital and medical school leadership, it was decided to begin with Shands employees. These individuals, who number about 7,000, are among the people with whom our faculty work directly on a day-to-day basis.

It should be noted that the Jacksonville campus was already far along the path of streamlined access to care. Over the past few years, under the leadership of Dr. Bob Nuss, the Jacksonville faculty practice has moved from phone answering at individual offices to a centralized call center. This center is now staffed by about 60 employees, answers 95,000 calls a month (and growing), covers 58 clinics (primary and specialty) and hospital radiology scheduling. Ninety-nine percent of calls are answered and 94 percent within 15 seconds. The center schedules appointments, and coordinates physicians and their offices for prescription refills and other tasks. It has added immeasurably to patient and physician satisfaction.

There were a number of key issues in preparing for the launch of GatorAdvantage in Gainesville. First, we needed a plan from each department on how they would implement the timely access goal. It didn’t need to be the same plan; the goal was explained to each department, and they were asked to develop a strategy to meet this goal in their particular situation. Second, we needed to develop a training program for the schedulers in each department. Finally, the more than 400 schedulers who schedule patients into our practice needed face-to-face training on how to implement the GatorAdvantage program.

The meeting in which it was decided to proceed with the above three-step process occurred on July 13. A date was set when GatorAdvantage would be launched: Aug. 23. There was much to do in six weeks!

As predicted, the faculty were indeed up to the task. Although a few specialties initially expressed reservations, when they learned that the entire COM clinical practice, along with Shands ancillaries, had committed to the effort, each department and division submitted a workable plan in time for go-live. In parallel, training materials were developed, and more than 400 schedulers were trained in over 30 two-hour training sessions.

On Aug. 18, we sent out a memo to all Shands employees advising them of the program. Shortly thereafter, the big day arrived. On Aug. 23, GatorAdvantage was launched according to plan and with nary a hitch. During the first week of GatorAdvantage, the number of Shands employees who were seen as new patients by UF faculty increased from a baseline of about 85 per week to 120. Since then, each week, the number of new patients has remained at the increased level of about 120. The anecdotes changed from reports of difficulty getting an appointment to thanks for making care more accessible. For example, one of the longest-serving Shands employees, who had long before started seeking care in the community because of difficulty getting appointments at UF&Shands, decided to try the faculty practice again and reported a great experience. And even organizations outside of Shands heard about the effort and called to find out how they could be included in the program.

In Jacksonville, there has already been a system in which all primary care offices have "held" same day appointment slots for urgent or employee requests and have mandates to follow managed care standards for timely patient access. Access has not been a significant concern at the primary care level, but it has been an issue in some specialties and that will be the main focus in Jacksonville.

Keeping with the theme of starting with our own community, GatorAdvantage will be extended to HSC faculty and staff on Nov. 15. This will add about 5,000 employees plus their families to the program. Once we’re sure we can provide timely service to this larger population of individuals, we will extend GatorAdvantage to all UF faculty and staff. This component of the plan is scheduled to start in about March of next year.

And getting a timely appointment is just the start of our promise to improve the patient experience. What’s next? Progress on parking! Many of our employees in Gainesville (especially Shands and HSC employees) can walk to their doctor’s office, since it may be nearby on campus. GatorAdvantage patients who must drive to a faculty office location, however, will not have to pay for parking. In Jacksonville, free parking is provided to all patients where parking fees are otherwise required.

And after a timely appointment and free parking? We must ensure excellence in all aspects of the experience from the patient’s perspective: not only the time spent with the doctor, but also with all aspects of the visit. Much as I heard personal experiences about the difficulty in getting an appointment, I have heard stories about multiple forms, extended waits, distracted staff and difficulties in scheduling lab tests and imaging studies and in obtaining results.

I thought of this when Kathy Luther, executive director of the Institute for Healthcare Improvement, lectured at our UF&Shands quality retreat in June. Paraphrasing her comments, she said, “When your friends are visiting Gainesville and ask for a restaurant recommendation, you give them the name of your favorite restaurant and a number to call. You don’t call the maitre d’ to let him or her know your friends will be in for dinner and to make sure that they won’t wait too long, that the right chef is in the kitchen and that a particular waiter serves them. You just know that it’s a great restaurant, and that the evening can be left in their hands.”

Taking a cue from this apt analogy, the next phase of our quality journey in the outpatient arena becomes clear — to improve all aspects of our patients’ experience before, during and after their visits with our UF faculty. We need a future of electronic forms completed in advance, no waits, easy patient access to their own secure portals for their personal health information and lab results, and warm, helpful communication throughout. This will be GatorAdvantage, Phase 2, a topic for another newsletter and a process that we will roll out in parallel with our enhanced access program over the next year. Furthermore, although we are learning how to re-engineer our clinical processes by working with our own community of employees at the University of Florida and Shands HealthCare, UF&Shands seeks to provide a uniformly excellent level of service to all of our patients.

For now, we’re extremely proud of the tremendous progress we have made in facilitating access by Shands employees to UF clinical faculty members, and look forward to providing the same level of access soon to UF faculty and staff. And we thank the many of you who have been our willing partners in this fine start and will be equally essential to all of our future efforts to make the UF&Shands patient experience everything all our patients deserve, no matter where they work!

Forward Together,

David S. Guzick, M.D., Ph.D. Senior Vice President, Health Affairs President, UF&Shands Health System