Advanced Access What, When, Why and How

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Advanced AccessWhat, When, Why and How?

• Jeff Harries

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What is Advanced Access?

• Definition
• Method of organizing a practice so patients are
  seen when they want to be seen.

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What is Advanced Access?

• Definition
• Method of organizing a practice so patients are
  seen when they want to be seen.
• Results
• better patient care, lower costs, higher practice
  revenue and higher physician, patient, and staff
  satisfaction.
• How
• It involves a better understanding of the factors
  making up the demand on the practices services
  and its ability to supply those services.

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How do you get there?

• Work down the Backlog
• Match Supply and Demand
• Dont let a Backlog develop (Do todays work
  today)

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Advanced Access Intelligent Access

• How to convince other physicians to move to make
  the change.

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Convincing Others to Jump out of the Plane

• Use a Stick Sticks dont work very well on
  mules or physicians.
• Use a Carrot Pay physicians to attend learning
  sessions.
• Ultimately the reason for change must be
  compelling Advanced Access is counterintuitive,
  we dont like failure, we dont like uncertainty.
  

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We Have Problems

• Patients get sicker waiting to see MD.
• Patients are more fearful.
• Patients resent delays.
• Patients get mad.
• Patients seek other advice.
• Patients are siphoned off to Walk-Ins.
• Patients crowd ERs.
• Patients dont get good CDM.
• Patients die.
• ALL OF THE ABOVE ARE ACCESS PROBLEMS.

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Advanced Access - Penticton

• Penticton GP for 17 years.
• Our Clinic consists of myself and two female
  part-time GPs (one of whom is my wife).
• We have 2200, 1000 and 500 patients,
  respectively.
• Special circumstances led us to consider and then
  start implementation of Advanced Access in our
  Clinic April 05

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Why Did We Change to Advanced Access?

• Large increase in demand due to Maternity Leave
  by one of our Clinic doctors.
• Old system of seeing patients was not going to be
  able to expand to meet increased demand.
• A Medical Post article spoke of one physicians
  very positive experience with Advanced Access.
• Primary Care Office Redesign Conference in
  Washington, D.C. March 05.

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My concerns about changing to Advanced Access?

• Create unrealistic expectations.
• Encourage unlimited demand.
• Would I burn-out?

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How can this be done?

• Do todays work today.
• Match the demand for Primary Care visits/calls
  with the capacity of the Clinic to deliver that
  care.

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Advanced Access

• How can we get from where we are to where we need
  to be?
• First The Physician must believe the current
  system is unworkable and something has to change.
• Second The Physician must be convinced Advanced
  Access needs to be part of the change.
• Third The Physician must commit to change.

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How to Improve Access

• Work down the Backlog
• Understand/Manage Demand and Capacity
• Reduce Appointment Types
• Plan for Contingencies
• Manage the Constraints
• Optimize the Care Team
• Synchronize Patient, Provider, and Information
• Optimize Rooms and Equipment

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Improvement Model
Source Associates in Process Improvement
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Practical Advice

• Spring is a good time to start.
• Cancel/Adjust things that dont add value.
• Cancel/Adjust all things that increase demand or
  decrease supply.

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Measurements

• Time to 3rd next available appointment
• Panel Size ( of patients in your Practice)
• Capacity (How much work can your Practice handle)
• Demand (What your patients need/want)
• Wait Lists (By appointment type)
• Continuity (Frequency pt. seen by own MD)
• No-Shows
• Revenues

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Consider

• The significant problems we have cannot be
  solved by the same thinking with which we created
  them.
• Albert Einstein

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• Moving to advanced access improves
  profitability, improves patient and physician
  satisfaction and very importantly it opens
  capacity for improving other intractable
  problems. Somewhat unexpectedly it also opens up
  access to emergency departments, hospital wards,
  and specialty clinics.
• Scaling Up the Deployment of Advanced Access
  A Way Out of Crisis. Marcus Pierson, MD
  Whatcom County, WA

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Improving Access

• Questions?

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Acknowledgements

• The Institute for Healthcare Improvement,
  (www.ihi.org)Associates in Process Improvement
  (www.apiweb.org) and Dr. Mark Murray
  Catherine Tantau (http//www.aafp.org/fpm/20000900
  /45same.html)
• pioneered much of the work described herein to
  improve access in healthcare.