Advanced Access

What can we accomplish in Leader?

November 2004

What is Advanced Access?

A way to improve patient access in general practice by ensuring a balance between demand for services and the capacity of the practice to deliver them

Helps practices to understand the size and nature of the needs of patients, and how to develop services to effectively meet them

Put the practice in control of their workload

How Does it Work?

Step 1: Dissatisfaction with life as you know it

Step 2: Understand the demand each day of a typical week

Step 3: Shape the handling of demand

Step 4: Working down the backlog by matching capacity to

demand Step 5:

Put contingency plans in place

Step 1: Dissatisfaction with Current System

Overworked

Frustrated

Never caught up

Stress

Step 2: Understanding Demand

Simply understanding how many people wish to be seen at the practice

Data collection for demand is straightforward

Step 3: Shape How Demand is Handled

Alternatives to face-to-face consultations Telephone follow-ups Email? – not likely… Referral to other professionals

Nurse Practioner Public Health Dietitian Pharmacy Home Care Etc.

Step 4: Working Down the Backlog

Most difficult part of achieving Advanced Access

Short periods of intense hard work by the practice team – but long-term benefits are well worth it

How Do We Work Down Backlog?

Distinguish between “good” and “bad” backlog “Good” = pre-booked appointments, follow-up

appointments “Bad” = patients that have been pushed to a future

appointment because no appointments are available on the day they want to be seen

Bad backlog must be cleared to achieve Advanced Access

How Do We Work Down Backlog?

Calculate the number of appointments that need to be cleared to work down bad backlog We’ll have help to do this!

Decide on best way to clear backlog Decide as a practice team

Possible Ways to Clear Backlog…

Add a few extra appointments onto each physicians’ schedule for limited time

Agree to no meetings or days off during “clearing” time

Run clinic for extended hours for limited time

Locum coverage

Step 5: Contingency Planning

Necessary for times when physicians are away or demand is unusually high Holidays, Flu season, etc.

Contingency Planning

3 steps will help in understanding what happens when capacity is reduced

Step 1: Calculate total number of appointments lost when physician(s) is away

Step 2: Link this information to your knowledge of daily demand to determine affect

Step 3: Identify ways to handle loss of capacity

Ways to Plan…

Handling demand in different ways

Adding appointments to remaining physicians’ schedule

No pre-booked appointments for first few days of physicians’ return

Locum coverage

Where Can We Start?

Step 2 – Understanding the Demand Baseline data collection

Surveys measuring patients’ baseline perception Given to patients as they leave the clinic Approved by HQC

Measuring Baseline Demand

Every day for a week, receptionists record the total appointment requests in the practice (usually done for ~4 weeks) Includes telephone, walk-up, and follow-up requests Identify follow-up appointments separately

Recorded on a “tick” sheet

Extremely simple to do

Look For the Patterns

Baseline data allows us to understand the scale of total demand for appointments

Helps to understand the variation that occurs on different days of the week Generally demand is high on Monday, tapers

off until Thursday, then rises again on Fridays

Some Challenges We’ll Face?

On-call physician No pre-booked appointments?

Working down the backlog Done when locums are already scheduled Dr. Koobair’s return Nurse Practioner’s arrival

Eatonia days Look at demand patterns on Tuesdays &

Fridays

Benefits

Physicians more in control of their workload

Practice staff are less stressed

Patients are happier

Decrease in out-of-hours patient visits

Decrease number of DNAs (Do Not Appear)

Support

We have support from the Saskatchewan Health Quality Council A couple of other sites throughout the province

(rural and urban) are also looking at implementing Advanced Access

Quotes

Physician: “We’ve certainly seen a huge increase in clinician satisfaction. I myself have found surgeries [clinics] much more acceptable, I feel much less stressed, much less hassled, I feel I’m actually giving much better patient care”.

Receptionist: “I’ve worked here for 15 years; the two weeks since we introduced advanced access have been the best of my working life”.

“Every system is perfectly designed to deliver the results it gets…

Pushing the old system harder won’t work, creating more of the old system won’t work, thinking differently does”