Transformation that works

Thinking about Visit Time from the Patient Perspective

Categories  |  Research, Design, Practice Tools

By Gregory Makoul, PhD

Process mapping is a major part of our work on the Anatomy and Physiology of Primary Care – it gives an immediate visual sense of the steps involved in care as well as the people involved in each step. The process maps also allow us to document three different aspects of visit time, which we characterize as value-added (or not) from the patient perspective: Value-Added, Essential Non-Value-Added, and Non-Value-Added.

Interestingly, the amount of Value-Added Time appears to be fairly consistent across practice sites: It takes about 30 minutes for a primary care team – not necessarily any one provider – to deliver direct patient care. On average, direct patient care takes less time in the small private practices; more time in the large residency clinics. The amount of Essential Non-Value-Added Time averaged around 10 minutes across the practice sites, with a similar tendency: less in small private practices and more in large clinics.

The amount of Non-Value-Added Time – time that is just plain wasted (from the patient perspective) – varied from an average of 12 minutes at one private practice to 80 minutes at one residency clinic. At that same residency clinic, the average amount of Non-Value-Added Time for walk-in patients – people with a health problem but no appointment – was well over two hours.

CIPCI has been working with this clinic to facilitate redesign. A group of physicians, residents, nurses, medical assistants and administrators used the “current state” process map and patient feedback to create an “ideal state” process map. We identified viable options for addressing Non-Value-Added Time, such as: (1) turning it into Value-Added Time by incorporating patient education and/or risk assessment; (2) changing the process to remove built-in waiting. Both providers and patients see the streamlined map – which eliminates wasted steps and reduces wasted time – as the basis for transformation to truly patient-centered primary care.

Current State

Ideal State

This is part 2 of a 2-part series on The Anatomy and Physiology of Primary Care. Read part 1, "The Anatomy and Physiology of Primary Care" here.

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