SPI Analysis

Case Overview:

This example will be a bit briefer, focusing on the interventions rather than the more drawn-out conversations on signals and node synthetizations. For a practitioner or administrator already quite familiar with the system, this is a more concise output. This network examines healthcare delivery barriers and enablers for patients in Greater Buenos Aires, who do not have insurance, and were in lower income classes. In this study, this accounts for 44 interviews. This network gives insights into the how these patients conceptualize the good and negative aspects of their care experiences.

Key Take Aways and Intervention Opportunities:

Long public wait times, morning waits at hospitals, and long waits in emergency rooms are well known issues in the public system. Efforts to modernize scheduling and rescheduling should be emphasized due to their ability to clear queues and decrease patient administrative burden. Online and phone booking, daily renewal and cancelation blocks, posting estimated waits, and priority slots for day-after returns could help alleviate some of these issues. With these interfaces enabler-leaning, capitalizing on existing efforts can help decrease wait time burdens. With greater certainty for intakes and better efficiency with provider time, dismissive events impacting patient trust and wasted time can be reduced. This also could also reduce patient financial burdens from greater certainty of receiving care and allowing them to stay in the public system.

In the same vein, scripting reception to greet, orient, and inform patients about intake procedures and general timelines. Scripted checkouts that confirm follow-up details and plans with patients decrease the likelihood of patients slipping through the cracks or becoming lost navigating the healthcare system. These help to alleviate uncertainty and decrease rumor-driven routing, mistrust, dismissive events, broken links, and treatment issues. This could be done by standing up ‘navigation tables’ to catch patients leaving and help orient their next steps and answer system questions. This is happening implicitly in some settings and should be expanded. The tables could be temporary accompaniment centers that orient patients and flip boca a boca in favor of care facilities when possible. These help patients build connections in the healthcare system with people familiar with its functioning and structure. This capitalizes on one of the primary already existing enabler clusters. These tables would help give the impression of a warm handoff between facilities (most often from a hospital to a sala). They would give up to date contact information and have updated lists of specialist providers to help orient and schedule patients.

From a financial standpoint, the overall worsening insurance situation has pushed substantial numbers of patients out of using their obra social. This is adding burden to an already overburdened healthcare system that is also struggling from austerity cuts. Many facilities have already stood up OS-checking operations to charge and seek reimbursements from insurance providers at no additional costs to patients. While these efforts are good, increase cash flow for facilities and help to increase provider compensation, some patients have interpreted these questions to be about whether or not they will qualify for care and do not share their insurance information. In some cases, care denial with insurance does exist, but in areas that it is not the case, reception staff should emphasize this fact to patients to increase adherence.

Quality and poor quality care are highly connected to care choices. If patients feel that they will have faster, higher quality care than in the public system, some will opt to save up to go to a private facility. However, this is a large financial strain for many. In order to improve local trust, quality care should be emphasized from front desk staff to medical providers. Though difficult in the rapid setting of the public system, emphasizing the need for providers to explain care is necessary to build trust and decrease patient conflicts. Poor quality incidents where patients interpret that they have ‘just been sent home’ causes a cascade of trust and boca a boca problems.