Advanced Access & Office Efficiency Learning Session 1

1. Advanced Access & Office EfficiencyLearning Session 1 Fall, 2010

2. Welcome • 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

3. GPSC and PSP • GPSC • who, what, why • Practice Support Program (PSP) • Who, what, why • Reimbursement • Accreditation – Main Pro C, Main Pro M1

4. Introduction • 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

6. Collaborative Aim 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 use to decrease the wait time of patients for, and at, appointments in Primary Care How will we know this has been accomplished? Change will be evidenced by improved 3rd next available appointment, and improved appointment cycle time.

8. Advanced Access • Physician:“I can do all of today’s work today.” • Patients: “I get the care I need when I need it.”

9. What is Advanced Access? • Seeing your own patients when they need and want to be seen • Eliminating delays for an appointment • Evidence-based

10. What Advanced Access is not! • 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!

11. 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

12. My experience • 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

13. Key concepts of Advanced Access • Understand, measure and balance your supply and demand • Work down your backlog • Reduce your scheduling complexity • Develop contingency plans

14. 1. Understanding Supply and Demand Demand (patient panel) panel: creates real work Waiting: work waiting to be addressed (backlog)  Delays If S < D: reservoir fills, backlog builds up, delays  reservoir Waiting Supply (Number of appointments available)

15. What is demand? • Requests for appointments • External – patient driven • Internal – practice driven

16. What is supply? • The number of appointment slots available in a given day • Supply is what you have in your schedule to meet your demand.

17. Supply:Demand • Reduce demand • Increase supply Supply Demand

18. Measures • Delay • Demand • Supply • Panel size • Physician profile report • Billing

19. Measuring delays • 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?

20. Measuring demand • 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

21. Tool to measure demand

22. Measuring supply • 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

24. 65% open 100% booked 35% booked Schedules Traditional model Example of an Advanced access model “Do yesterdayswork today.” “Do today’s work today.”

25. 2. Reducing the Backlog (the reservoir) • 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

26. Calculating backlog

27. Activity • Review the measurement tools • Review your schedule • Assess backlog

28. Strategies for Reducing Backlog • 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

29. Reducing the Backlog • Review call back standards or policies • Prescription renewal • Chronic disease/multiple follow-ups • Bring in locum or share/overlap with other physicians or practices

30. 3. Reducing scheduling complexity • Reduce appointment types • Use “truth in scheduling” • Review and revise scheduling “rules”

31. 4. Contingency Planning • Planning for time out of office anticipated or unanticipated

32. “Freeze/Unfreeze Strategy” Before holiday begins:– freeze all appointment slots for physician’s 1st week back (1st week back) …/

33. Freeze/Unfreeze Strategy On Monday of the last week of holiday, open the schedule for the Monday morning of the 1st week back (1st week back) …/ MOA will continue to unfreeze mornings on a day-by-day basis …

34. Freeze/Unfreeze Strategy On the Monday of the 1st week back, open the afternoon appointments for that same Monday (1st week back) MOA will continue to unfreeze afternoons on a day-by-day basis …

35. Break

36. The Model for Improvement • 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)?

37. Model for Improvement What are we trying to accomplish? How will we know that a change is an improvement? What changes can we make that will result in improvement? Act Plan Study Do

38. “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.”

39. D S P A D S P A A P S D Try a few small tests of change… Reduction of types down to long and short? DATA Cycle3: Pick a future day in the schedule just beyond the 3rd next available, and start booking by short and long time slots. 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? 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? Aim: To reduce the number of appt. types to short and long

40. Where do I start? • What are you going to do next Tuesday? • What is your aim? • Determine how you will measure/track improvement

41. Patient considerations • What do you tell patients about your changes? • How will you get the message across? (brochures, posters, etc) • Use of the MOA “script”

42. Action Period • Timeframe • RST Support • Data/measures

43. Good Luck!