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Volume 50, Number 6
November/December 2005

  • INTERVIEW
    Interview with Chip Holmes, CHE, Administrator, Littleton Regional Hospital , Kyle L. Grazier
  • FUNDING
    Patterns of Financing for the Largest Hospital Systems in the United States , William O. Cleverley and Sarah Jane Baserman
  • COMMUNICATION
    Dealing with “Difficult” People, Paul Preston
  • ARTICLES
  • Self-Assessment of Cultural and Linguistic Competence in an Ambulatory Health System, M artha A. Medrano, Jean Setzer, Steve Enders, Raymond M. Costello, and Viola Benavente
  • Visits to the Emergency Department as Transactional Data, Patricia B. Cerrito and David Pecoraro
  • Reinventing Veterans Health Administration: Focus on Primary Care, Brent Armstrong, Odette Levesque, Jonathan B. Perlin, Cathy Rick, and Gordon Schectman
  • FELLOW PROJECT
    Design and Implementation of Comprehensive Heart Failure Management Program, Carol S. Edwards
    View the appendices for the the Fellow Project by Carol Edwards

 

Executive Summary
Self-Assessment of Cultural and Linguistic Competence in an Ambulatory Health System M artha A. Medrano, Jean Setzer, Steve Enders, Raymond M. Costello, and Viola Benavente

The University Health System (UHS) leaders organized a comprehensive planning process of its ambulatory care system. As part of this planning process, UHS assessed the cultural and linguistic competence of its outpatient environment. This assessment was conducted within the context of standards outlined in the U.S. Department of Health & Human Services (2001) Standards for Cultural and Linguistically Appropriate Services, using a multimethod approach. This multimethod approach included (1) a review of the organizational profile, (2) a review of organizational documents, (3) a review of policies and procedures, (4) clinic site visits, (5) a staff survey, (6) patient and provider focus groups, and (7) interviews with key stakeholders in the community.

Generally, the UHS was found to have several strengths that enable it to continue meeting the medical needs of its target populations. To develop greater capacity in the areas of cultural and linguistic competencies, the UHS should continue to promote respect for diversity by focusing on attitudes; beliefs; behaviors; practices; and communication patterns associated with race, ethnicity, religion, socioeconomic status, historical and social context, physical or mental ability, age, gender, sexual orientation, generational status, and acculturation level. Recommendations for achieving a more culturally competent healthcare organization are provided.

Executive Summary
Visits to the Emergency Department as Transactional Data Patricia B. Cerrito and David Pecoraro

Patients arrive at the hospital emergency department for treatment on a random basis. The amount of time required for treatment is a function of the triage level, the patient diagnosis, and the congestion that exists in the emergency department (ED) at the time of patient arrival. The implementation of electronic medical records in the ED permits the accurate tracking and examination of time to allow for improved scheduling of personnel and for the development of protocols for diagnoses that occur on a daily basis in the ED.

The SAS Institute in Cary , North Carolina , has developed a method called High Performance Forecasting System that allows for the prediction of time series with random time points. The target variable is the amount of time needed to treat individual patients from the time they enter the system through triage to the time they are discharged. Variability in treatment time by ED personnel can also be examined. Results indicate that there is a “cut point” during the day when the time needed to treat each patient increases. In addition, some specific diagnoses can be anticipated on a regular basis, and the amount of time needed on a daily basis can be predicted by using the forecasting system. Personnel can be scheduled in accordance with the peak treatment time.

Executive Summary
Reinventing Veterans Health Administration: Focus on Primary Care Brent Armstrong, Odette Levesque, Jonathan B. Perlin, Cathy Rick, and Gordon Schectman

Can we improve access in primary care without compromising the quality of care? The purpose of this article is to demonstrate how timely access to primary care can be achieved without compromising the quality of the care being delivered. The Veterans Health Administration (VHA) is an integrated healthcare system that has implemented change to improve primary care access to the veterans it serves, while not just maintaining the quality of care but actually improving the quality of care.

Many healthcare executives are struggling with achieving desirable access to care and continuity of care. To confront this problem, many large and small practices have initiated an approach know as advanced clinic access , open access, or same-day scheduling, introduced by the Institute for Healthcare Improvement (IHI). This approach has increasingly been used to reduce waits and delays in primary care without adding resources. To measure quality of care, specific performance measures were developed to quantify the effectiveness of primary care in VHA. Although it was initially viewed with concern and suspicion and was seen as a symptom of unnecessary micromanagement, healthcare team members were encouraged to use performance feedback as an opportunity for systems improvement as well as self-assessment and performance improvement for the team. All quality data are posted quarterly on a VHA internal web site, providing visible accountability at all levels of the organization. Clinical workflow redesign leads to reduced wait times without compromising quality of care. These large system improvements are applicable to large and small organizations looking to tackle change through the use of a collaborative model.