Www.pspbc.ca Advanced Access & Office Efficiency Learning Session 1 Fall, 2010.

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Advanced Access & Office Efficiency

Learning Session 1

Fall, 2010

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At the end of today’s session, participants will:

› be able to describe advanced access and how it can benefit their practice

› understand a process for trying small changes to improve access in their practice

› have a plan for trying some small changes over the next couple of months

Welcome

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GPSC

› who, what, why

Practice Support Program (PSP)

› Who, what, why

› Reimbursement

› Accreditation – Main Pro C, Main Pro M1

GPSC and PSP

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All systems work best when they work without a delay Delays exist in family practices when patients are

waiting for an appointment and while waiting at an appointment

Reducing these delays has benefits of:

› Clinical outcomes for patients

› Satisfaction of patients, physicians and staff

› Costs

› Revenue

› Patient/provider relationship

Introduction

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The care of patients will be redesigned to improve access,

capacity and efficiency.

How will the aim be accomplished? Advanced Access, and Office Efficiency change packages will be

useto decrease the wait time of patients for, and at, appointments

inPrimary Care

How will we know this has been accomplished? Change will be evidenced by improved 3rd next available

appointment,and improved appointment cycle time.

Collaborative Aim

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Collaborative Measures

Delay for appointment

Cycle times

Patient experience – Access

Patient experience – Office Efficiency

Provider and staff experience

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Physician:

“I can do all of today’s work today.”

Patients:

“I get the care I need when I need it.”

Advanced Access

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Seeing your own patients when they need and want to be seen

Eliminating delays for an appointment Evidence-based

What is Advanced Access?

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Ensuring you see more patients Carving out time in your already full schedule Asking patient to call back the next day to schedule an

appointment on “same day” A government plot to make physicians work harder!

What Advanced Access is not!

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My experience – Dr. ______________

Before advanced access: Patient care Physician quality of life MOA quality of life Financial e.g. walk-in losses Delay No shows Patient dissatisfaction

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After advanced access: Improved patient care:

“I can do all of today’s work today”

› Reduction in delay for appointments Improved physician quality of life

› Leave on time

› Efficient appointments

› Fewer patient “lists” Improved MOA quality of work life

› Less time on the phone

› Less negotiating with patient Financial

My experience

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Key concepts of Advanced Access

Understand, measure and balance your supply and demand

Work down your backlog Reduce your scheduling complexity Develop contingency plans

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1. Understanding Supply and Demand

panel: creates real work

Waiting: work waiting to be addressed (backlog) Delays

If S < D: reservoir fills, backlog builds up, delays

Waiting

reservoir

Demand (patient panel)

Supply (Number of appointments available)

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Requests for appointments

External – patient driven

Internal – practice driven

What is demand?

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The number of appointment slots available in a given day

Supply is what you have in your schedule to meet your demand.

What is supply?

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Reduce demand

Increase supply

Supply:Demand

Demand

Supply

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Delay Demand Supply Panel size

› Physician profile report

› Billing

Measures

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To measure the delay for appointments and to correct for cancellations we use the third next available

appointment

Next available appt: (could be cancellation) 2nd next available appt : (could be cancellation) 3rd next available appt: (measure of access)

Measure the number of days to the 3rd next?

Measuring delays

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Record every request for an appointment Include appointment requests from all sources Count demand on the day the request comes in

regardless of when the appointment date is scheduled Track demand daily

Measuring demand

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Tool to measure demand

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Choose a typical week in the future. Avoid weeks before, during and immediately after holidays

Count every available appointment slot each day and record it

If there are predefined double slots, count them as two If there is more than one physician, count for each of

them separately

Measuring supply

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Schedules

100% booked

“Do yesterdays work today.”

Traditional model Example of an Advanced access model

“Do today’s work today.”

65% open 35% booked

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What is meant by “Backlog”? The total work that is waiting for you between today and

the third next available appointment

Types of backlog: Good backlog:

› Appropriate follow up

› Planned future visits Bad back log:

› Today’s work pushed to the future – appointments requested for today that could not be accommodated today

› Scheduled appointments that may be unnecessary

2. Reducing the Backlog (the reservoir)

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Calculating backlog

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Review the measurement tools Review your schedule Assess backlog

Activity

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Review schedule & push ahead some good backlog Review schedule & deal with any appointments via

phone or email, if possible Temporarily increase hours

› Schedule a couple of extra appointment slots/day

› Add another day or half-day if not working full time

Strategies for Reducing Backlog

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Review call back standards or policies

› Prescription renewal

› Chronic disease/multiple follow-ups Bring in locum or share/overlap with other physicians or

practices

Reducing the Backlog

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Reduce appointment types Use “truth in scheduling” Review and revise

scheduling “rules”

3. Reducing scheduling complexity

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4. Contingency Planning

Planning for time out of office anticipated or unanticipated

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“Freeze/Unfreeze Strategy”

Before holiday begins:– freeze all appointment slots for physician’s 1st week back

(1st week back)

…/

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Freeze/Unfreeze Strategy

…/

(1st week back)

MOA will continue to unfreeze mornings on a day-by-day basis …

On Monday of the last week of holiday, open the schedule for the Monday morning of the 1st week back

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Freeze/Unfreeze Strategy

(1st week back)

MOA will continue to unfreeze afternoons on a day-by-day basis …

On the Monday of the 1st week back, open the afternoon appointments for that same Monday

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Break

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An evidence based approach to making sustainable changes

Involves finding the answers to the following questions:

› What are we trying to accomplish (Aims)?

› How do we know change is an improvement (Measures)?

› What changes can we make that will result in an improvement (Tests of change)?

The Model for Improvement

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What are we trying toaccomplish?

How will we know that achange is an improvement?

What changes can we make thatwill result in improvement?

Model for Improvement

Act Plan

Study Do

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Measures TargetCurrent

(Baseline)

Practice Aim

Delay for appointmentAble to offer same day, if requested

Cycle times[practice &

context specific]

__ minutes% improvement

Patient experience – Office Efficiency (1)

80% answer“most of the

time”%

Patient experience – Access (2)

80% answer “Very easy”

%

Provider and staff experience (3)

80% answer “most of the

time”%

“When you visit your doctor’s office, how often is it well organized, efficient, and does not waste your time?”“How easy is it for you to see your family physician when you need to?”“I start and end my day on time.”

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Try a few small tests of change…

Aim: To reduce the number of appt. types to short and long

Reduction of types down to long and short?

A PS D

D SP A

DATAD SP A

Cycle 1: Pick one morning in the next week to appoint patients into short or long appointment types. Did the appointments start and end on time?

Cycle 2: Choose a week in the future to book appointments according to short and long time slots. Was it easy to book this way?

Cycle3: Pick a future day in the schedule just beyond the 3rd next available, and start booking by short and long time slots.

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Where do I start?

What are you going to do next Tuesday?

What is your aim? Determine how you will

measure/track improvement

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What do you tell patients about your changes? How will you get the message across? (brochures,

posters, etc) Use of the MOA “script”

Patient considerations

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Timeframe RST Support Data/measures

Action Period

Good Luck!