CC
IHHC: Enhancing Accessibility Across MSK Facilities: A Quality Improvement Initiative
The IHHC (QI) Project Spotlight is a periodic feature on the ABPMR News Center to highlight exemplary IHHC projects submitted by your fellow diplomates (or residents) for continuing certification (CC) credit. Diplomates can use the IHHC Project Spotlight as a tool to plan their own IHHCs or as a way to connect with other diplomates doing similar work.
What is the problem you are trying to solve?
Patients with disabilities often have unique accessibility, communication, and scheduling needs that are not consistently recognized or accommodated during the appointment scheduling process. This can create unnecessary barriers to care, increase patient burden, and contribute to challenges for both patients and providers. For example, patients with cognitive, learning, or mental health disabilities may find it difficult to navigate back-to-back appointments or visits scheduled across multiple locations. Similarly, patients with mobility impairments may benefit from coordinated scheduling that minimizes travel within or between sites. This project aims to better understand these needs and identify opportunities to incorporate disability-informed scheduling considerations that support a more accessible, patient-centered care experience while respecting individual patient preferences.
What data (objective measurements) do you have that supports this as a problem?
Patient/caregiver satisfaction surveys and faculty/support staff engagement surveys have consistently identified gaps in the recognition and proactive management of disability-related accommodation needs. Patients reported barriers to accessing care and navigating healthcare facilities, while staff described inconsistent processes for identifying and documenting accommodation needs prior to visits. These findings demonstrated a clear need for a standardized workflow to improve accessibility, enhance the patient experience, and ensure patients receive appropriate support throughout their care journey.
What is your opportunity statement? State the goal you hope to achieve.
Survey findings, combined with operational expertise, identified an opportunity to enhance the scheduling experience for patients with disabilities. To support this effort, we developed a disability/impairment reference guide with corresponding scheduling considerations. In addition, we developed workflows to alert providers and clinic staff of patient preferences and needs. These recommendations are intended to promote patient-centered care and improve both patient and provider experiences, while preserving flexibility and patient preference in scheduling decisions.
What is the underlying cause of the performance/quality problem?
The underlying causes of this performance and quality gap include:
Limited understanding of disability-related needs during scheduling. Existing scheduling workflows do not consistently incorporate information about patients' disability- or impairment-related needs, making it difficult to proactively address potential barriers to care.
Lack of standardized scheduling guidance. Staff may not have access to clear, practical recommendations for accommodating common disability related needs during the scheduling process, leading to variability in scheduling practices.
Insufficient identification of patient-specific barriers. Scheduling workflows may not routinely identify challenges that could affect a patient's ability to attend and navigate appointments, including cognitive, learning, mental health, mobility, sensory, or communication impairments.
Missed opportunities to optimize the patient experience. Without disability informed scheduling considerations, appointments may be arranged in ways that increase patient burden. For example, patients with cognitive, learning, or mental health disabilities may find back-to-back appointments or visits across multiple locations difficult to manage. Similarly, patients with mobility impairments may experience challenges associated with extensive travel within or between facilities.
Limited integration of accessibility needs and patient preferences into scheduling decisions. While patient preferences should remain central to scheduling decisions, there is an opportunity to better align appointment coordination with individual accessibility needs and preferences.
Collectively, these factors may create unnecessary barriers to care, limit accessibility, and negatively impact both patient and provider experiences. This project aims to address these gaps by developing disability-informed scheduling recommendations that support more accessible, patient centered care.
What change(s) did you implement?
We developed and shared an “MSK Accessibility Feedback Form” with the Patient and Family Advisory Council for Quality (PFACQ) to build understanding around how we can improve access to MSK facilities for people with disabilities. Questions were developed in accordance with the Center for Disease Control (CDC) Disability and Health Overview and the World Health Organization’s (WHO) International Classification of Functioning, Disability and Health (ICF) from 2001.
Based on responses received, we implemented a standardized scheduling workflow designed to identify and address accessibility needs at the time of new visit scheduling. The intervention included the development of a disability/impairment reference list with corresponding scheduling considerations and scripted language to facilitate consistent and patientcentered conversations about accessibility needs.
The reference list, workflow, and scripted language were reviewed and approved by the Patient and Family Advisory Council for Quality (PFACQ), the Abolishing Barriers and Limitations for Everyone (ABLE) Employee Resource Network, and the Rehabilitation Medicine Operations Team prior to implementation. As part of the new visit scheduling process, staff were prompted to ask patients whether they had any disabilities or impairments that could affect their care experience. When a patient identified a disability or impairment, staff used follow-up questions to understand scheduling preferences, including appointment timing, location considerations, and any information the patient wished their care team to know for the visit. Accessibility needs were documented in scheduling notes and communicated to providers and clinic staff, allowing accommodations to be planned in advance. For patients with mobility impairments, staff also encouraged them to bring any adaptive equipment used to their appointments.
Following implementation of this workflow, we surveyed office staff and faculty to assess the impact of the intervention on scheduling practices, communication, and the ability to identify and address patient accessibility needs. Feedback received was used to evaluate the effectiveness of the workflow change and inform future improvements.
The goal of this change was to improve identification of accessibility needs, reduce barriers to care, and enhance the patient and provider experience through more individualized, disability-informed scheduling practices.
Did you achieve your goal or target from your opportunity statement? What data do you have to support your conclusion?
Yes. Through data analysis, we determined that we achieved our goal. Initial survey data was received from 13 members of the PFACQ. Of the respondents, 92% reported experiencing a disability or impairment that impacted their access to care. The most common impairments reported were related to cognition (n=7), mobility (n=6), hearing (n=4), and vision (n=4). Site-specific access challenges were also obtained regarding access to facilities and clinical areas.
Analysis of clinic rooming times and visit duration documented in the medical record demonstrated shorter visit times when a disability or impairment was identified and documented prior to the visit, compared with visits in which a disability was not identified in advance and with all patient visits, including those without a self-reported disability or impairment.
Among faculty and staff respondents, 33% reported that visit scheduling was more appropriate when a patient's access needs were documented before the visit. Additionally, 67% of faculty reported that knowing about a patient's disability or impairment in advance was helpful in preparing for and coordinating the visit.
There were several limitations to this pilot. The workflow was implemented for new patient visits and was not extended to follow-up visits. In addition, patients were not surveyed after implementation to fully assess the impact of this workflow change on their experience and access to care.
How will you maintain the success of your project going forward?
To ensure the long-term sustainability of this initiative, we plan to expand the workflow to include follow-up visits and implement it beyond our service. We are coordinating meetings with Operations and our institution's Falls Committee to recommend modifications to the electronic medical record, standardizing documentation of patient access needs, and incorporate this documentation into the registration process to reduce the administrative burden on office staff. In addition, we plan to conduct quarterly audits to monitor adherence to the workflow, evaluate its effectiveness, and identify opportunities for ongoing improvement.
