Designing and Implementing a Patient Access Model

Children's Health (CH) is a 600‑bed, academic-affiliated children’s hospital whose outpatient clinics focus on subspecialized and high-acuity care provided by the faculty of the University of Texas Southwestern Medical Center. Children’s Medical Center Dallas was ranked in all 10 pediatric subspecialties by U.S. News & World Report in 2022–2023.

CH’s outpatient programs had historically struggled to provide timely referral processing and access to care, with new patients routinely waiting three to six months for appointments—resulting in dissatisfaction on the part of patient families and referring providers alike. When CH engaged ECG, the system had no standardized approach to scheduling, templating, evaluating capacity, or assessing and improving access.

ECG worked with CH to evaluate its outpatient access and construct an approach to rapidly improve its outcomes. After an initial assessment, CH and ECG moved forward with the following primary activities:

• Pilot full-scale optimization efforts for the urology and orthopedics programs, including redesigning the scheduling and referral processing workflows, optimizing Epic templates, realigning staff, and implementing an Epic toolkit for access and scheduling workflows. This pilot led to the access optimization of two additional complex programs, neurology and endocrinology.
• Evaluate system-wide referral processes and introduce best practice technology solutions, optimize practice workflows, and improve processes for referring providers. ECG assembled a multidisciplinary team to design consistent, centralized processes for indexing, preregistering, authorizing, and scheduling inbound referrals. Removing this function from individual clinics can help facilitate a seamless, end-to-end referral process.
• Analyze provider patient-facing time and run opportunity diagnostics comparing patient-facing time, patient demand, provider productivity, and patient access to enable CH to prioritize high-need programs.

By using Epic tools, redesigning provider templates, and optimizing nonclinical workflows, ECG’s efforts helped the pilot programs increase their average session durations and templated slots per session, adding over 160 net-new slots per month for each program and increasing urology provider utilization by 11%. The standardized templates enabled online scheduling for new and established patients, introducing a digital entry point for consumers. The methodology has since been rolled out to nearly all specialties. In addition, CH used the workflows created by ECG to standardize the referral process to provide a consistent experience for patients and their families across all specialties. 

ECG’s provider capacity analysis helped CH understand the variations in patient contact hours and slot count across the organization. The urology program used this information to increase session duration for 50% of provider templates, while the orthopedics group expanded 81% of its templated sessions. The analysis enabled CH to prioritize other programs for optimization based on access trends, volume, and productivity outcomes and provided a framework for robust policies and procedures regarding provider templated time.