Delay of care is a persistent and undesirable feature of current health
care systems. Although delay seems to be inevitable and linked to resource
limitations, it often is neither. Rather, it is usually the result of unplanned,
irrational scheduling and resource allocation. Application of queuing theory
and principles of industrial engineering, adapted appropriately to clinical
settings, can reduce delay substantially, even in small practices, without
requiring additional resources. One model, sometimes referred to as advanced access, has increasingly been shown to reduce
waiting times in primary care. The core principle of advanced access is that
patients calling to schedule a physician visit are offered an appointment
the same day. Advanced access is not sustainable if patient demand for appointments
is permanently greater than physician capacity to offer appointments. Six
elements of advanced access are important in its application
balancing supply and demand, reducing backlog, reducing the variety
of appointment types, developing contingency plans for unusual circumstances,
working to adjust demand profiles, and increasing the availability of bottleneck
resources. Although these principles are powerful, they are counter to deeply
held beliefs and established practices in health care organizations. Adopting
these principles requires strong leadership investment and support.
Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more
Subscribe for full-text access to content from 1998 forward and a host of useful features
Activate your current subscription (AMA members and current subscribers)
Purchase Online Access to this article for 24 hours
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and
Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early
dhildhood mortality and growth failure data and their association with maternal
Thank you for submitting a comment on this article. It will be reviewed by JAMA editors. You will be notified when your comment has been published. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest*
Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 145
Customize your page view by dragging & repositioning the boxes below.
More Listings atJAMACareerCenter.com >
All results at
and access these and other features:
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.