Access: The Overlooked Driver of Patient Safety

By Molly Siegel, MPH & Elizabeth Woodcock, DrPH, MBA, FACMPE, CPC

Patient Access Collaborative member Victor J. Hassid, MD, MBA of UT MD Anderson, and colleague Haytham M. Kaafarani, MD, MPH of Massachusetts General Hospital recently published a sentinel article in JAMA titled “Patient Safety Begins with Access.” The article highlights an idea that will resonate with access leaders: patient safety is adversely impacted by poor access to care.

At the Collaborative, we see this reality every day. Drs. Hassid and Kaafarani’s article offers an important opportunity to reflect on what access leaders have long understood but that health systems are only beginning to recognize. Safety risks emerge not only in the exam room, but in the process of getting a patient there.

Across health systems, patients encounter barriers before care begins. Referrals wait in queues for review. Records must be located, ingested, and indexed. Imaging and results must be identified and uploaded, and requests vetted. Insurance authorizations must be obtained. Each step seems logical and reasonable on its own. Together, however, they create days or weeks of delay when time matters most.

From the Patient Access Collaborative’s perspective, these are not simply operational inconveniences. We resoundingly agree with Drs. Hassid and Kaafarani’s conclusion: access barriers equate to patient safety risks.

The Safety Blind Spot

Health systems have built sophisticated infrastructures to monitor clinical safety. We track complications, analyze adverse events, and conduct root cause analyses. But these frameworks usually begin once a patient has already entered care.

The challenge is that many safety risks occur earlier than patients walk through our doors. Indeed, as the authors observe: “Access to care - despite being the gateway to all downstream clinical activity - remains largely outside [a health system’s] safety framework.” The authors further assert: “Medical error is a privilege for those who overcame the first safety barrier and accessed the system."

Access delays are often discussed as workflow problems, template design flaws, call handling challenges, or operational inefficiencies. Rarely are access delays examined with the same rigor as traditional safety events. When access breaks down, patients experience real harm, yet the system may not identify it as a safety failure, if they recognize the failure at all.

Administrative Decisions, Clinical Consequences

Many of the barriers patients encounter are administrative by design. Referral pathways, authorization requirements, scheduling rules, and clinic capacity decisions all shape how quickly patients receive care.  These decisions may occur far from the exam room, but their consequences are clinical.

At the same time, responsibility does not solely rest with administrative systems. Drs. Hassid and Kaafarani call for shared accountability: “Importantly, these reviews must collaboratively include both clinical and administrative leaders, recognizing that access failures occur at the intersection of both domains."

When access falters, the ripple effects are felt throughout the patient’s care journey. Delays in evaluation may postpone diagnoses, complicate treatment decisions, and always increase anxiety for patients and families. Access is a shared responsibility – and requires collaboration amongst all stakeholders to address.

Why Measurement Matters

One reason access failures often go unnoticed is that they are difficult to see without data.

Metrics such as new patient lag, time to consultation, referral conversion, and appointment lead times help illuminate where systems are slowing patients down. They are only valid, however, if measured from the perspective of the patient. Being “schedulable” is an exceptional internal measurement of operational effectiveness, but it creates a blind spot for the patient’s care journey.

These indicators are not just operational metrics. They signal whether patients can reliably enter the system in time to receive care.

When those metrics do not illuminate the full picture, or when the metrics deteriorate, patient safety may be at risk.

The First Link in the Safety Chain

The growing conversation around access and safety is an important one. It encourages health systems to treat delays in care, coordination breakdowns, and prolonged wait times with the same seriousness as other safety signals.

For access leaders, this perspective reinforces something we have long believed.

Before a diagnosis is made, before treatment begins, before any clinical decision occurs, a patient has to get in.

As the authors assert, “Access is not an administrative prelude to care. It is the first - and most fragile - link in the chain of patient safety.”

We thank Drs. Hassid and Kaafarani for their contribution to our field.