Transcript Slide 1
Advanced Access & Office
Efficiency
Learning Session 1
Fall, 2010
www.pspbc.ca
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
2
GPSC and PSP
GPSC
› who, what, why
Practice Support Program (PSP)
› Who, what, why
› Reimbursement
› Accreditation – Main Pro C, Main Pro M1
3
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
4
5
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.
6
Collaborative Measures
Delay for appointment
Cycle times
Patient experience – Access
Patient experience – Office
Efficiency
Provider and staff experience
7
Advanced Access
Physician:
“I can do all of today’s work today.”
Patients:
“I get the care I need when I need it.”
8
What is Advanced Access?
Seeing your own patients when they need and want to be seen
Eliminating delays for an appointment
Evidence-based
9
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!
10
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
11
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
12
Key concepts of Advanced Access
Understand, measure and balance your supply and
demand
Work down your backlog
Reduce your scheduling complexity
Develop contingency plans
13
1. Understanding Supply and Demand
Demand (patient panel)
panel: creates real work
reservoir
Waiting
Waiting: work waiting to be
addressed (backlog) Delays
If S < D: reservoir fills, backlog
builds up, delays
Supply
(Number of appointments available)
14
What is demand?
Requests for appointments
External – patient driven
Internal – practice driven
15
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.
16
Supply:Demand
Supply
Reduce demand
Increase supply
Demand
17
Measures
Delay
Demand
Supply
Panel size
› Physician profile report
› Billing
18
Measuring delays
To measure the delay for appointments and to correct for
cancellations we use the third next available appointment
Next available appt:
2nd next available appt :
3rd next available appt:
(could be cancellation)
(could be cancellation)
(measure of access)
Measure the number of days to the 3rd next?
19
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
20
Tool to measure demand
21
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
22
23
Schedules
Traditional model
100% booked
“Do yesterdays work today.”
Example of an Advanced
access model
65% open
35%
booked
“Do today’s work today.”
24
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
25
Calculating backlog
26
Activity
Review the measurement tools
Review your schedule
Assess backlog
27
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
28
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
29
3. Reducing scheduling complexity
Reduce appointment types
Use “truth in scheduling”
Review and revise
scheduling “rules”
30
4. Contingency Planning
Planning for time out of office anticipated or unanticipated
31
“Freeze/Unfreeze Strategy”
Before holiday begins:
– freeze all appointment slots for physician’s 1st week back
(1st week back)
…/
32
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 …
33
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 …
34
Break
35
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)?
36
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
37
“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.”
Measures
Delay for appointment
Cycle times
Target
Current
(Baseline)
Practice Aim
Able to offer
same day, if
requested
[practice &
context specific]
__ minutes
% improvement
Patient experience –
Office Efficiency (1)
80% answer
“most of the time”
%
Patient experience –
Access (2)
80% answer
“Very easy”
%
80% answer
“most of the time”
%
Provider and staff
experience (3)
38
Try a few small tests of change…
Reduction of types down to
long and short?
Cycle3: Pick a future day in the
schedule just beyond the 3rd next
available, and start booking by
short and long time slots.
A P
S D
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
39
Where do I start?
What are you going to do
next Tuesday?
What is your aim?
Determine how you will
measure/track improvement
40
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”
41
Action Period
Timeframe
RST Support
Data/measures
42
Good Luck!