title: Improving access to specialty care.
abstract: BACKGROUND
  Waits and delays plague health care systems worldwide, and wait times for most specialists exceed those for primary care practices. In office-based practices, the provider office presence is not diluted by competing indispensable activities, and the demand for service is most often for a single type, or stream, of office-based appointment demand. In the more complex specialty practices, however, the demand streams for office visits and other services compete for provider time and dilute the supply of office visits.
  Seven strategies for reduction of delay can be applied, not only at all steps in patient flow and for all demand streams but also at all steps (for example, office visit, diagnostic procedure, surgery, follow-up) and within all specialty care types and ranges of practice. Each specialty care practice will need to discover how to use the basic principles and implement customized solutions within its own unique environment. Although it is ultimately critical to eliminate the delays in all streams of service, the focus is on the application of change strategies at the initial step between primary care and all specialty care practice types. The strategies are (1) balance supply and demand at each step in the chain, (2) work down the backlog, (3) reduce appointment types, (4) independent contingency planning for all variation, (5) reduce the demand for visits, (6) increase the supply, and (7) improve the efficiency of the office work flow.
  
  
  CONCLUSIONS
  Specialists support various, distinct demand streams that require demand/supply balance to achieve optimal system performance. If demand/supply balance exists within any stream, waits can be minimized, and the practice can choose time frames within which to balance workload.
authors.affiliation: Mark Murray & Associates, Sacramento, California, USA. murraytant@msn.com
authors.forename: Mark F
authors.initials: MF
authors.lastname: Murray
mesh_terms: D001071:Appointments and Schedules; D017598:Efficiency, Organizational; D006285:Health Planning / Q000458:organization & administration*; D006296:Health Services / Q000600:supply & distribution; D006297:Health Services Accessibility / Q000458:organization & administration*; D006801:Humans; D008511:Medicine / Q000458:organization & administration*; D011320:Primary Health Care / Q000458:organization & administration; D013038:Specialization; D014850:Waiting Lists