Advanced Access Learning Module

1

• Advanced Access Learning Module

Learning Session 1
2
Fraser Health Practice Support Program Team
Physician Team Members
Non-Physician Team Members

• Jivi Khehra
• Heather Glen-Kenney
• Michelle Medland
• Sophia Tanaka
• Supported by
• Joan Rabillard, Manager, Primary Care

• Dr. Andre van Wyk
• Dr. Brian Brodie
• Dr. Baldev Sanghera
• Dr. David Wong
• Dr. Vineet Nair
• Dr. Werner Spangehl

3
Agenda

• Introduction
• Background
• Measurements
• Break (15 minutes)
• Action Plan
• Compensation and Support
• Conclusion
• Question and Answer

4
Physician Practice Information
(Insert Practice Info)

• Geographical Area
• How many physicians in your practice?
• What changes have you implemented?
• What were some of the benefits/barriers you
  experienced?
• Why are you passionate about teaching this
  module?
• Why do you think other teams should implement
  this module?

5
What is Advanced Access scheduling?

• An innovative approach for patient appointment
  scheduling
• Its a structured and systematic method to help
  ensure that patients can see their physician when
  they need to and at a time that is convenient for
  them.

Dr. Jeff Harries Pauline Sykes, MOA,
Penticton If you can see a patient when they
want to be seen, thats absolutely the best time
to see them. Its the most efficient and
compassionate time. Dr. Jeff Harries
6
Vision- Advanced Access

• The main objective of Advanced Access is to do
  Todays work Today

7
Benefits

• The Business Case
• Average of 10 25 increase in net revenue when
  60-70 open access achieved
• More time for planned care
• Short visits recapture the EASY visits
• Free more time for coordinated, planned care
• e.g., take advantage of the Complex Care Fees

8
(No Transcript)
9
AA Module Checklist
10
Change Management Theories

• Old style of change
• The Installation method

New style of change The Implementation/Engagement
method
11
Not enough planning????
12
Plan-Do-Study-Act (PDSA)
13
PDSA Advanced Access

• Plan
• The purpose of this stage in the PDSA cycle is to
  help you analyze your current situation, and
  identify the goals and outcomes you want to
  achieve.

Learning Session 1

• Do
• This stage of the PDSA cycle is designed to help
  you implement Advanced Access in small chunks to
  see how it works for you.

Action Period One
14

• Study
• This is the stage in the PDSA cycle where you
  measure and evaluate the changes you have
  implemented to see if you have achieved your
  goals.

PDSA Advanced Access
Learning Session 2 3

• Act
• This is the stage in the PDSA cycle that helps
  you identify practical methods for sustaining the
  changes you have made in your practice over the
  long term.

Action Period Two
15
Advanced Access?2 methods

• Carve Out/Block Scheduling
• Optimal Access Scheduling

16
Carve Out/Block Scheduling

• A portion of the daily schedule is reserved for
  same-day appointments and the rest of the
  schedule is pre-booked. Triage is required and
  non-urgent care is pushed into the future.
  Predict urgent demand and reserve time to meet
  it.
• E.g., 2 hours are blocked in the physicians
  schedule morning and afternoon for urgent same-
  day appointments.

17
Carve Out/Block Scheduling

• Cons
• Artificial capacity because appointments are
  either booked, pre-scheduled or reserved for
  same-day urgent needs and non-urgent work
  continues to be delayed.
• Competition between urgent vs. routine
  appointments continues extends the wait for
  routine appointmentspatients adapt their
  requests to become urgent to jump queue.
• Pressure on MOA staff to borrow from future
  urgent care appointment slots.
• In a fee-for-service office, there may be revenue
  concerns if any appointments remain un-booked and
  underutilized.

• Pros
• Improvement over the traditional model movement
  towards patient-centered care.
• May partially meet urgent patient demand.
• Incremental change to a new scheduling approach.
• Easier for part-time providers who may have less
  flexibility in their work schedules (e.g., tend
  to focus primarily on direct patient care time).
• Incremental approach to same- day scheduling.

18
Optimal Access Scheduling

• Patients schedule appointments for their
  preferred time (i.e., future or same day).
• No triage is required as all appointments are
  handled in the same manner. Meet demand as it
  emerges. Do todays work today.
• E.g., 60-70 of the schedule is open for
  same-day appointments.

19
Optimal Access Scheduling

• Cons
• Paradigm shift--away from a queue indicating
  demand/quality of care provided.
• On average, 65 - 80 of visits will be same-day
  due to patient preferences and physician
  requested follow-ups.
• May have less predictable scheduling.
• In a fee-for-service office, their may be revenue
  concerns if any appointments remain un-booked and
  underutilized.

• Pros
• Eliminates the distinction between urgent and
  routine appointments.
• Patient-centered triage.
• Work is done at the time it emerges.

20
Current Schedule sample
Advanced Access sample schedule
Reduction of backlog
21
Optimal Advanced Access Schedule Sample
Schedule -PM
Schedule -AM
22
Key Concepts

• Panel Size
• Supply
• Demand
• Backlog
• Action Plan

23
What is Panel Size?

• Panel size quantifies the patient population for
  which a provider is responsible and can be
  measured by calculating the number of unique
  patients seen by a provider within a specific
  time frame.
• The panel size should reflect only active
  patientsthose who have received care in the
  practice within the past eighteen months.

24
Panel Size Worksheet
25
What is Supply?

• The number of appointment slots in the
  Physicians schedule (available work time).

26
Supply-Worksheet
27
What is Demand

• Demand is the number of appointments patients
  request (work generated).
• Two types external and internal.

28
External/Internal Demand
Internal
External

• Appointment requests, regardless of the
  appointment date requested.
• Requests for referrals, telephone calls, walk-ins.

• Return visits booked today, no matter where they
  end up on the schedule.

29
Demand-Worksheet
30
3rd Next Available

• The third next available appointment represents
  that average length of time, in days, between the
  day a patient makes a request for an appointment
  with a physician and the third next available
  appointment, regardless of appointment reason.

31
Third Next Available Worksheet
32
What is Backlog?

• Unmet demand (work that should be done).

33
Backlog Calculation

• Supply minus Demand Backlog
• Backlog represents how many appointments need to
  be taken care of prior to starting Advanced
  Access booking.

34
Good/Bad Backlog

• Good Backlog
• Patients who want to book into the future or are
  returning for a follow-up visit.

• Bad Backlog
• Patients who would prefer to be seen sooner, but
  cannot get an appointment.

35
How to improve access

• Work down the backlog.Offload work, put in more
  hours, dont add to the backlog. Takes 3?6 weeks.
• Understand and manage demand and capacity.Review
  general patterns of demand and capacity, and plan
  to increase capacity at times when demand is
  high.
• Reduce appointment types.Only two are needed
  short appointments for regular visits, and long
  appointments for physicals and new patients.

36
Backlog Elimination Group Discussion

• Facilitator will give each table a slip with a
  number of backlog patients
• Please talk about as many options as possible to
  eliminate the number of backlogged appts

37

• Efficiency Tip
• Give patients a letter outlining office policies
• or put a poster in the waiting area.
• Letter could contain information on
• Cancellation Policy
• Prescription Renewal Policy
• Emergencies
• Insurance Forms
• Lab Test Results

38
Break?15 Minutes
39
Recap Learning

• Panel Size ? active number of patients you have
  seen in the last 18 months

• Supply ? the available work time

• Demand ? the work generated

• Backlog ? unmet demand

40
What is an Action Plan?

• It is a written plan of what the practice is
  going to do during the Action Period.
• It defines the goal(s) as well as identifies
• Who is responsible for each task
• When each task is to be completed
• How the task is to be completed

41
(No Transcript)
42
Group Activity Discuss benefits and barriers of
Advanced Access

• 15 minutes
• Begin by finding out name and practice of each
  person at your table work group.
• Person whose first name begins with letter
  closest to A begins discussion.

43
Group Activity Action Plan

• 45 Minutes
• Create your action plan with your team (each
  practice physician and their MOA).
• Share your action plan with your table work group.

44
Cartoon
45
Team Change

• The difference between
• change (external)
• and transition (internal adjustment process)
• The secret for change to be effective
• internal transition has to happen
• internal transition occurs differently for each
  person
• Three Stages of adapting to change
• Endings Transition Beginnings

46
Reasons for negative reactions to change

• Sense of unfairness in the treatment of
  individuals
• Personal uncertainty and insecurity about the
  future
• Perceived powerlessness
• Resistance to the need to adapt to change

• Address the underlying causes with The Three Is
• Information
• Involvement
• Individual attention

47
Action Period One Support

• Bi-weekly conference calls hosted by your PSP
  Regional Support Team
• Teleconference July 25 2007 1200-100pm
• All participants to dial
• 604-899-2339
• Long distance 1-877-385-4099
• Enter Number 8430245
• Peer-to-peer support with others in this work
  group (your colleagues at the table)
• One-on-one problem solving
• Via email psp_at_fraserhealth.ca
• Via telephone [phone]

48
Agenda Learning Session 2

• How to balance supply and demand
• How to eliminate backlog
• How to initiate Advanced Access
• Create an Action Plan for backlog elimination
• Contingency planning for implementation

49
Remember to Bring Back to Learning Session 2

• Please bring back with you
• Square Wheels worksheet
• Please think about how easy was it for you to
  change
• Also, how easy is it to get someone else to
  change
• Measurements
• Panel Size/Supply/Demand/Backlog/Third Next
  available

50
Feedback Form
51
Compensation Structure
Learning Sessions
Action Periods
Potential Total 3,506.64
52
Worksheets

• Please ensure the following worksheets are in
  your binder
• Panel Size Worksheet
• Supply Worksheet
• Demand Worksheet
• Square Wheels Worksheet
• 3rd next available Worksheet
• Backlog Calculation Worksheet
• Advanced Access Module Overview
• Action Plan
• AA Module Checklist

53
Practice Efficiencies
Leaders
Admin Team
Quality Improvement Cycle

• Pick two square wheels from your practice
• One that affects you
• One that affects someone else
• Work through a PDSA Cycle with each

Practice In-efficiencies
Something that affects only me
Something that affects me and someone else
Plan Do Study Act
Plan Do Study Act
54

• Book Appointment
• Today
• When patient wants to
• be seen

Appointment
Patient calls requesting an appointment

• Book Appointment
• 2-4 weeks into
• the future

Advice/ Information

Prescription Renewal
Happy Team

Diagnostic Test Results
Support Staff
Not so Happy Team
55
Efficiency Tip Certain phrases and their
accompanying tone of voice and body language may
trigger defensiveness in callers or visitors.
Phrases to avoid with patients I cant do
that I dont know Just a moment,
please No Youll have to.or You must Your
task is to find alternatives that keep you in
charge of the conversation and the patient
feeling positive!
56
What questions do you have?