Practice Support Program Advanced Access Learning Session

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Practice Support ProgramAdvanced Access Learning
Session 1

• Dr. Joanne Larsen
• Dr. Sue Turgeon
• Dr. Anis Lakha
• Cheryl Rivard

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Agenda

• Introductory information for CDM learning
• session
• Welcome introductions
• Where we came from and where we are going
• Understanding supply demand
• Tools for change
• Plan for next session

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Learning Session Goals/Objectives

• To understand the link between supply and demand
  in an appointment schedule
• Be able to calculate 3rd next, backlog and
  measure demand
• At the end of the session have enough info to get
  started!

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Current Situation

• Fully booked office
• MOA triaging patients
• Fit ins
• Patients waiting
• No shows
• Walk in

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Financial Consequences

• 3 x 200 x 27.9016,740

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North Vancouver Survey

• 50 use walk in
• 92 have a GP

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• Do Todays Work Today

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Benefits

• Increased capacity
• Time to see complex care patients
• Increase income
• Improve patient care
• Decrease office staff stress
• Respectful of patients
• Reduce medicolegal risk

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SoWhere Do We Start?

• How accessible is your schedule?
• How much work has backed up?

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3rd Next Available Appointment

• Measures GPs appointment accessibility
• 1st 2nd appointments are likely cancellations
• Allows for
• Goal setting (e.g. 0 days)
• Tracking (is backlog creeping in?)

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Measuring 3rd Next

• Choose appointment type ( short/long)
• Choose day and time
• Count the of calendar days a patient will wait
  from the day he phones until the day of the 3rd
  next open appointment

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3rd Next Available Appointment

• Example of a run chart

Days
Weekly progress
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Backlog How Much Work Has Backed Up?

• Work that is booked into the future
• Good - Follow-up that requires passage of time
• Bad - Todays work pushed into the future
  because todays schedule is full

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Calculate Your Bad Backlog

• Count total booked appointments until 3rdNext
  (BACKLOG the BAD)
• Subtract total Appropriate future booked
  appointments ( BACKLOG the GOOD)
• This leaves TRUE BACKLOG the UGLY !
• Divide by appointments/hour hours of
  yesterdays work to be done ( the REALLY UGLY
  !!!)

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Plan to Work it off

• Add 1 hour/week
• Stop adding to backlog (make every effort to do
  todays work today)

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Review Your 3rd Next Backlog
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Supply Demand The Key To Backlog Control
Panel creates real work Waiting creates
rework If S ? D - backlog creeps in
Patient Demand
reservoir
Waiting
Physician supply to do the work
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Demand

• Work that arises from your patient panel
• Predictable
• Measurable

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Demand

• External
• Patient initiates or is sent by 3rd party (phone
  call / walk in)
• Internal
• Please call in to review
• Book to see me in 1 week
• Non-Appointment work/requests
• Prescription refills / test results

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Why Measure?

• To adjust your appointment schedule to best meet
  your pattern of demand.
• To understand proportion of Internal/External
  demand and begin to shape it as able.

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How To Measure

• Refer to worksheet
• Who?
• When?
• How?

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Supply

• Can be more variable than demand
• How many appointments per week are available to
  look after the patient panel?

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Balancing Supply Demand

• Match supply to demand
• E.g. ? clinic hours Monday / Friday (golf on Wed)
• Build in adjustments for predictable blips (long
  weekend)
• ? appointment types and rules (? flexibility,
  patient focused)

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Balancing Supply Demand

• Increase supply
• Pay attention to continuity
• Consider group visits / flu shot clinics

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Balancing Supply Demand

• Shape demand
• Avoid PAPs Follow-ups on Mondays ( Fridays)
• Consider longer F/U intervals
• .cc results to patients

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Balancing Supply Demand

• Contingency Plans
• Huddles
• Add extra appointments at end of clinic
• Minimize regular recalls in Jan/Feb
• Dr Staff prepare patients
• Talk up locum
• Dont say come 1st week back

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Freeze/Unfreeze Vacation Reentry Survival Plan

• Before the holiday
• Docs talk up locum/order extra refills/DONT
  say come in the week Im back!
• MOAs freeze the schedule for 1 2 weeks
  following vacation

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Freeze/Unfreeze Vacation Reentry Survival Plan

• Holiday begins ..
• Docs try to loose that pager feeling
• MOAs - talk up the locum and get todays work
  done while doc is away / start to open up
  morning appointments for the post vacation week

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Freeze/Unfreeze Vacation Reentry Survival Plan

• After the holiday
• Docs - start thinking about your next time away
  
• MOAs open up afternoon appointments for same
  day work

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Goal Setting 3rd Next / Backlog
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Tools For Change

• Every system is perfectly designed to produce
  the results it gets Don Berwick, IHI

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Tools For Change

• If we keep doing what were doing, were going
  to keep getting what we got. Yogi Berra

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Walk-In Lessons

• Schedule
• Access

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Tools for ChangeThe Quality Improvement Model

• PDSA Cycles
• PLAN assess need, create an action plan
• DO implement incremental changes
• STUDY measure progress
• ACT identify practical methods to sustaining
  long-term change

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PDSA Cycles
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PDSA Example

• Plan Create a Carve Out schedule for open
  access
• Do Block off 2 hours Q afternoon
• Only fill appointments same day
• Give appointments when needed
• Study After 2 weeks
• 2 hours not enough time
• Demand ?Supply
• Staff stealing time
• Too restricted in PM only
• Act Next 2 weeks try
• Educate patients
• Increase time blocked off to 3 hours
• Spread time to AM PM

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PDSA Example

• Plan Primary Care Improvement
• Do Try improving pt. access to GPs
• Study Improve Patient provider satisfaction
• Act Roll it out to others

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PDSA Example

• Plan Increase supply by decreasing
  appointment time
• Do 10 minute appointments
• Study Always behind schedule!
• Act 20 minute appts. for PAPs and gt75yrs.

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Review of Today

• Demand
• Supply
• Panel Size
• 3rd Available Appt- Baseline
• Backlog Tips
• Plan Do Study Act
• Your Plan?

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What are YOU going to do differently tomorrow?