Case Study: VVHVVH has a serious problem: A major strategic objective of the health systemwas to grow its ambulatory care network, but the organization is facing anumber of challenges. Although a new billing system was installed and var-ious reimbursement-maximization strategies were executed, total costs inthe system exceed revenue. This was occurring even though the clinic stafffelt busy and backlog appointments were growing. Analysis of clinic data419420Putting It All Together for Operational E xcellencealso indicated an increasing number of patients were canceling appointmentsor were no shows.In addition, a new group of multispecialty and primary care physicianshad been created from the merger of three separate groups; this clinic isaggressively competing with VVH for privately insured patients. The newlarge clinic is making same-day clinic appointments available and heavilyadvertising them.The board of VVH asked the chief executive officer (CEO) to developa plan to address this growing concern. The CEO first formed a small strat-egy team to lead improvement efforts; its first step was to assign the chiefoperating officer, chief financial officer, and medical director to direct theplanning and finance staff on the improvement team.VVH ultimately decided that it needed to increase the number ofpatients seen by clinicians and begin to implement advanced access in its clin-ics. Because VVH believes in knowledge-based management and sharing inimproved methods of delivering health services, the organization has madeits data and information available on the companion web site. VVH invitedstudents and practitioners to help them improve this system.1. Frame the original issue for VVH. Mind maps and RCA may be usefulhere.2. How would you address the no-shows and cancellations issue?3. Develop a project charter for one project associated with VVHs problems.4. Develop a balanced scorecard for VVHs clinics.5. If VVH decided that it should focus on increasing throughput in thesystem, how would you go about doing this? Be specific.6. Would simulation be a useful tool in VVHs quest to implementadvanced access? Why or why not? How would you go about imple-menting advanced access? Be specific.

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