Transcript TITLE (all caps, Arial 32pt, white, centered)

WAVE 6
Advanced Access, Efficiency and Chronic
Disease Management in Primary Healthcare
Date:
Name of Presenter:
www.HQOntario.ca
WAVE 6
Agenda
• Introduction
• About Health Quality Ontario
• Introduction to Advanced Access
• Overview of the Learning Community
• Overview of Wave 6
• Questions & Discussion
www.HQOntario.ca
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Health Quality Ontario (HQO)
HQO is an independent agency created by the
Government of Ontario to:
(a) monitor and report;
(b) support continuous quality improvement;
(c) promote health care - supported by the best available
scientific evidence.
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Accessible Care
“People are able to get the right care at the
right time in the right setting by the right
health-care provider”
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Waiting…for a Family Physician in Ontario
% of adults
able to see
their GP same
or next day
2011 report on Ontario’s Health System; HQO
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Getting
to GP
Delay
Delay
Delay
Delays are common in our system:
Getting
Tests
Seeing
Specialist
Dissatisfaction, adverse clinical outcomes, increased costs
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How Are You Doing?
• Patients have trouble booking appointments?
• Receptionists say “no” a lot?
• Feel overwhelmed with demand?
• Find it difficult to bring patients back for follow-up?
• Experience a lot of “no shows”?
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What is Advanced Access?
• Timely patient access to a scheduled appointment
• Measured in days:
• Third Next Available Appointment (TNA)
• Excellent access is when a practice can accommodate a
patient’s day & time of choice with his or her primary
care provider
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“Advanced Access” is about
 Reducing delay
 Patients see their provider on their day of choice
 Doing today’s work today
 Matching provider supply to patient demand
 Improving the patient/provider/team experience
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Access is not about
• Limiting patient’s ability to book in advance
• Prioritizing access over continuity
• Making you work harder/ faster/ longer
• Promoting a walk-in culture
• Unleashing limitless demand
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Moving Towards Advanced Access
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Access to care can be improved….
By understanding and balancing your Demand and Supply
Demand
Supply
(From your panel)
(By your care team)
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First, consider your annual Demand & Supply
• How many
appointments are
requested by your
patients in a year?
• How many
appointments do you
offer in a year?
Appointments/week x
weeks worked/year
Panel size x revisit rate
Demand
Supply
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Next, measure your Demand
and Supply on a daily basis
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Demand
From your panel
External
Demand
• How many people ask
for an appointment
each day?
Mon
Tues
Wed
• How many return visits
are booked?
Thurs
Internal
Demand
IIIII
IIIII
IIII
IIIII
III
IIIIII
IIIII
IIII
Fri
IIIII
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III
Supply
By your care team
Total
Demand
Supply
Mon
#
#
Tues
#
#
appointments are
Wed
#
#
offered each day?
Thurs
#
#
Fri
#
#
• How many
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Does Demand balance with Supply?
• If not, test changes until a balance is achieved.
• Balancing Supply and Demand involves examining the
way you deliver care and takes time.
For ideas on how to test changes to
achieve a balance, visit the
Learning Community Gateway
www.hqolc.ca
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Once the care team has balanced Supply &
Demand… Reduce your backlog
How large
is your
backlog?
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To Measure Backlog:
1. Count number of booked appointments between now and
the third next available appointment (TNA)
2. Subtract “Good Backlog”
3. Add temporary supply to catch up until provider/care team
is doing today’s work today
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Going forward, offer
Supply that matches Demand
=
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Maintaining Access requires matching
supply to demand – daily & weekly
External
Demand
Internal
Demand
Mon
#
#
Tues
#
#
Wed
#
#
Thurs
#
#
Fri
#
#
#
#
#
#
#
#
#
#
#
#
Mon Tues Wed
20
Thurs Fri
Important Strategies
1. Booking Appointments:
• Offer an appointment today, or if patient requests, another day.
• Book return visits early in the day and late in the week.
2. Maintain Good Access to Care
• Contingency plan for variation
• Continue testing improvement ideas and measuring
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6 Principles of Access
1. Understand and Balance Supply and Demand
2. Increase Supply of Visits
3. Reduce Demand for Visits
4. Reduce Appointment Types and Times
5. Reduce Backlog
6. Develop Contingency Plans
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Case Studies with Advanced Access
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Days till 3rd next Available Appt
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15
10
5
0
Month 1
Month 2
Month 3
Month 4
MD1
Month 5
MD2
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MD3
Month 6
Month 7
Month 8
6 Principles of Efficiency
1. Balance supply and demand of non-appointment
work
2. Synchronize patients, providers, information,
rooms and equipment
3. Anticipate and predict patient needs
4. Optimize rooms, staff and equipment
5. Manage constraints
6. Eliminate waste
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What’s in it for me and my patients?
 Improved patient satisfaction
 Improved physician and staff satisfaction
 Improved ability to organize care processes and
continuity of care
 Less cost to healthcare system
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Challenges
• Measurement
• Engaging staff
• Change
• Sustainability and Spread
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Learning Community: 3 Main Elements
Active
Learning
Cycles
Infrastructure
Gateway
Support
• Model for Improvement, CDPM Framework
• Clinical Practice, Evidence-based Guidelines
• A virtual on line real-time workspace
• QI coach
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Benefits of a Learning Community:
Learn
• Learn
Share
• Share
Learning
Community
• Innovate
• Improve
Innovate
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Improve
WAVE 6
Access plus Chronic Disease Management
• Growing population in Ontario
• Demanding on primary care and all levels of health care
• Improvements in primary care can impact:
• Patient outcomes
• Entire system of care
• Better patient transition between levels of health care
improves patient experience.
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WAVE 6
Wave 6 Highlights
• Starts March 20th, 2013
• 9 month + 3 months data collection
• Apply until March 1st, 2013
• Readiness assessment required
• Coach support by stream
• Team obligations
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WAVE 6
Questions ?
Website: www.hqolc.ca
Contact us:
[email protected]
www.HQOntario.ca
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www.HQOntario.ca
www.HQOntario.ca