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The “Nuts and Bolts” of Implementing Shared Medical Appointments: The Harvard Vanguard Medical Associates Experience

Berger-Fiffy, Jill MHA, CMPE

The Journal of Ambulatory Care Management: July/September 2012 - Volume 35 - Issue 3 - p 247–256
doi: 10.1097/JAC.0b013e3182582c0a
Primary Health Care in Europe

Harvard Vanguard Medical Associates (Harvard Vanguard) decided to develop a Shared Medical Appointment (SMA) program in 2007 for a variety of reasons. The program has launched 86 SMAs in 17 specialties at 12 sites and has exceeded 13 000 patient visits. Currently, the practice offers 54 SMAs and is believed to be the largest program in the country. This article provides an overview regarding staffing, space and equipment, project planning, promotional materials, training programs, workflow development, and the use of quality improvement (ie, LEAN) tools used to monitor the work to be completed and the metrics to date.

Shared Medical Appointment Program, Harvard Vanguard Medical Associates, Newton, Massachusetts.

Correspondence: Jill Berger-Fiffy, MHA, CMPE, Shared Medical Appointment Program, Harvard Vanguard Medical Associates, Riverside Center, 275 Grove St, Ste 3-300, Newton, MA 02466 (

The author thanks Dr Ed Noffsinger, the “Father of Shared Medical Appointments,” who spent 2 years at Harvard Vanguard Medical Associates to teach us the tools and methods. We credit him for the approach that has become the Harvard Vanguard Medical Associates model and is discussed in this document. Also, credit is due to Dr Zeev Neuwirth, as his chief disciple and the in-house leader of our early efforts. Lastly, Deb Prescott, Former Administrative Director of the Shared Medical Appointment, Program is acknowledged for her leadership and commitment in developing this program.

Additionally, this work is the effort of the many Shared Medical Appointment clinicians, senior leadership, administrators, site champions, supervisors, documenters, behaviorists, medical secretaries, medical assistants, and nurses. Without their commitment to the model and providing the best patient care experience, the program would not exist.

The author has disclosed that she has no significant relationships with, or financial interest in, any commercial companies pertaining to this article.

© 2012 Lippincott Williams & Wilkins, Inc.