Table 2

Examples of Key Findings by Step in the Primary Care Process

Key FindingScheduling AppointmentsCheck-inRoomingClinician VisitLaboratory and Imaging
Information flowReason for visit not always clearly communicated or understood, leading to patients getting visit scheduled for something that could have been dealt with over the telephoneChanges to addresses or insurance information need to be updated in multiple placesProblems identified by MAs during screening not always seen by physicianMedication lists frequently not reconciled appropriately because patients assume the computer is correctLaboratory orders not entered correctly or did not print, which causes confusion or errors when patient goes to laboratory
Alignment of goals and expectationsOpen-access scheduling can conflict with patient’s need to be able to plan aheadPatients frustrated with not being seen when late, even when public transportation issues were the causeMAs caught between need to keep flow moving and increasing number of screening questions they are expected to askPatients have multiple concerns, and clinicians may be willing to address only 1 or 2 or prioritize chronic disease managementPrior authorization requirements of insurance companies conflict with patient and clinician desire for rapid access to needed tests
Personal relationshipsKnowing which patients will have trouble scheduling follow-up can help care coordinators decide whom to schedule in advancePatients feel comfortable with front desk staff whom they have known for many yearsPatients more likely to discuss true reason for visit with staff they know wellTrust between patients and clinicians develops with timeWalking patients to laboratory prevents them from leaving before having tests completed
  • MA=medical assistant.