Developing a New Paradigm for Healthcare Delivery: Lessons Learned from Same-Day Access.

Abstract

Goal: Excessively lengthy wait times for appointments with clinicians are a major source of frustration for patients, and difficulties with access represent a public health problem facing populations across all societies. As delays in care have been associated with inferior outcomes, same-day appointments have been proposed as a patient-centric means of improving healthcare delivery. However, this paradigm represents a radical shift from conventional scheduling tactics, and skepticism has long existed regarding its feasibility and real-world applicability to clinical practice. Given the limited data available about same-day access and the lack of guidance on this strategy, the need to evaluate experiences and engage in introspective reflection (i.e., examine thoughts, emotions, judgments, and perceptions) for quality improvement are paramount. Thus, the purpose of this study was to review a single-institutional practice with same-day access, focusing on lessons learned over a two-year period.

Methods: From March 2021 to March 2023, a total of 4,301 consecutive patients with newly diagnosed cancer were offered same-day appointments as part of a prospective pilot initiative conducted in the outpatient setting at a tertiary-based academic medical center. Systematic analysis demonstrated the positive impact of this initiative on access-related benchmarks. A retrospective review was conducted to identify core themes pertaining to the feasibility of the initiative with respect to its design and implementation. An interpretive synthesis was then presented in descriptive fashion.

Principal findings: Of the 3,414 patients scheduled, 477 (14%) opted for same-day appointments. While same-day appointments significantly reduced the time to consultation and treatment for patients with newly diagnosed cancer, the initiative presented new challenges-both expected and unexpected-that could have hindered its development, acceptance, and adoption. These challenges related to scheduling capacity, logistical coordination, workflow efficiency, resource allocation, and cultural change. A consistent, proactive management approach, coupled with an unwavering commitment to communication, was required to overcome these operational barriers.

Practical applications: Same-day appointments in the ambulatory setting has the potential to improve health outcomes and care quality, while fundamentally changing the way healthcare is delivered for the betterment of patients. However, thoughtful preparation and team-based planning are imperative to establish a methodical approach that will optimize the likelihood of success. Given the potentially disruptive nature of this paradigm, the need for steady leadership, accompanied by the consistent promotion of standardized guidelines, is critical to ensure engagement among all stakeholders. Lastly, the importance of promoting positive cultural change and creating an environment of shared purpose, trust, and transparency cannot be overemphasized.