Defining Access Management in Healthcare Delivery Organizations

Abstract Background: Managing patient access to care in healthcare delivery organizations is complex, yet instrumental in shaping patient healthcare experiences. Conceptual work to understand the dimensions of access and access management is critical for improvement initiatives. This work aims to advance primary care access management practice and research to support healthcare delivery organizations. Methods: We convened a stakeholder panel, informed by evidence review, to establish access and access management definitions. Stakeholders were selected based on a patient-centered framework and included patients, healthcare providers, policy makers, product makers, payers, and purchasers of healthcare. Methods included evidence review; written surveys; in-person stakeholder panel discussions; and concurrent sub-panels to establish recurring, cross-panel themes. Results: Literature review results showed variation in access concept definition but consistent use of the temporal measure “time to third next available appointment” as an indicator of access. Panel deliberations highlighted the importance of patient-centeredness and resulted in three comprehensive definitions: 1) “ Access management encompasses the set of goals, evaluations, actions and resources needed to achieve patient-centered healthcare services that maximize access for defined eligible populations of patients; ” 2) “ Optimal access management engages patients, providers, and teams in continuously improving care design and delivery to achieve optimal access;” and 3) “ Optimal access balances considerations of equity, patient preferences, patient needs, provider and staff needs, and value.” Conclusions: Access to healthcare is substantially determined by how healthcare delivery organizations manage it. The developed concepts of access management suggest that access management, improvement initiatives, and research studies require ongoing attention to organizational processes and multiple relevant outcomes. Healthcare organizations and researchers can use the definitions as starting points for initiatives to improve access management and evaluations of access initiative success.