Improving Outpatient Experience Through A Six-Hospital Quality Improvement Collaborative: A Longitudinal Evaluation

Introduction: Outpatient waiting, uncertainty about delays, and unreliable clinic flow can adversely affect patient experience. Six hospitals in a national government health system with persistently low outpatient experience scores participated in a collaborative targeting waiting and delay communication.

Methods: This prospective, multicenter quality improvement report evaluated a 14-month Institute for Healthcare Improvement-style collaborative implemented simultaneously across six hospitals. A four-domain change package addressed workload, patient arrivals, expected-wait and delay communication, and the waiting environment. Three learning sessions alternated with three action periods and site visits. Quarterly Press Ganey scores were described for each intervention hospital; an unweighted mean across all 23 system hospitals provided organizational context. Monthly measures included average waiting time, clinic starts, environmental compliance, waiting-time screen implementation, and the Workload Index. Analyses were descriptive.

Results: All six intervention hospitals ended above their Quarter 1 score, with absolute gains of 0.41-5.47 points. The contextual 23-hospital mean increased from 69.46 in Quarter 1 to 73.55 in Quarter 5. Mean waiting time was 24.2 minutes during Months 1-3 and 24.7 minutes during Months 12-14. Environmental compliance increased from 7.0% to 64.7%, waiting-time screen implementation from 3.7% to 11.4%, and clinics starting on time from 92.6% to 99.4%. The Workload Index changed from 1.13 to 1.00.

Conclusion: The collaborative was associated with heterogeneous improvements in outpatient experience and selected implementation measures without a consistent reduction in waiting time. Reliable clinic operations, communication, and waiting environments may contribute to patient experience, but the uncontrolled design does not establish causation.