title: A case study of quality improvement methods for complex adaptive systems applied to an academic hepatology program.
abstract: Although demands for greater access to hepatology services that are less costly and achieve better outcomes have led to numerous quality improvement initiatives, traditional quality management methods may be inappropriate for hepatology. We empirically tested a model for conducting quality improvement in an academic hepatology program using methods developed to analyze and improve complex adaptive systems. We achieved a 25% increase in volume using 15% more clinical sessions with no change in staff or faculty FTEs, generating a positive margin of 50%. Wait times for next available appointments were reduced from five months to two weeks; unscheduled appointment slots dropped from 7% to less than 1%; "no-show" rates dropped to less than 10%; Press-Ganey scores increased to the 100th percentile. We conclude that framing hepatology as a complex adaptive system may improve our understanding of the complex, interdependent actions required to improve quality of care, patient satisfaction, and cost-effectiveness.
authors.forename: John
authors.initials: J
authors.lastname: Fontanesi
authors.forename: Anthony
authors.initials: A
authors.lastname: Martinez
authors.forename: Toritsesan O
authors.initials: TO
authors.lastname: Boyo
authors.forename: Robert
authors.initials: R
authors.lastname: Gish
mesh_terms: D000046:Academic Medical Centers / Q000458:organization & administration*; D001071:Appointments and Schedules; D002140:California; D003362:Cost-Benefit Analysis; D005762:Gastroenterology / Q000458:organization & administration*; D006297:Health Services Accessibility; D006801:Humans; D019982:Organizational Case Studies; D017060:Patient Satisfaction; D058996:Quality Improvement; D014850:Waiting Lists