VVH has a serious problem: A major strategic objective of the health system was to grow its ambulatory care network, but the organization is facing a number of challenges. Although a new billing system was installed and various reimbursement-maximization strategies were executed, total costs in the system exceed revenue. This was occurring even though the clinic staff felt busy and backlog appointments were growing. Analysis of clinic data also indicated an increasing number of patients were canceling appointments or were no-shows.

In addition, a new group of multispecialty and primary care physicians had been created from the merger of three separate groups; this clinic is aggressively competing with VVH for privately insured patients. The new large clinic is making same-day clinic appointments available and heavily advertising them.

The board of VVH asked the chief executive officer (CEO) to develop a plan to address this growing concern. The CEO first formed a small strategy team to lead improvement efforts; its first step was to assign the chief operating officer, chief financial officer, and medical director to direct the planning and finance staff on the improvement team.

VVH ultimately decided that it needed to increase the number of patients seen by clinicians and begin to implement advanced access in its clinics. Because VVH believes in knowledge-based management and sharing in improved methods of delivering health services, the organization has made its data and information available on the companion website. VVH invited students and practitioners to help them improve this system. You will write a paper addressing the following components:

1. Frame the original issue for VVH. Mind maps and RCA may be useful here.

2. How would you address the no-shows and cancellations issue?

3. Develop a project charter for one project associated with VVH's problems.

4. Develop a balanced scorecard for VVH's clinics.

5. If VVH decided that it should focus on increasing throughput in the system, how would you going about doing this? Be specific.

6. Would simulation be a useful tool in VVH's quest to implement advanced access? Why or why not? How would you go about implementing advanced access?