Optimizing Primary Care through AIM Access. Improvement. Measures.

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Optimizing Primary Care through AIMAccess.
Improvement. Measures.
Clinic Team Orientation See your own
patients and dont make them wait Dr. Mark
Murray
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Overview

• Overview
• What is AIM?
• Why AIM?
• Components
• Expectations of Participation
• Getting Started
• Facilitation
• Desired Results
• Actual Results

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Canadian Context

• 25 of Canadians wait 6 days or more to see a
  physician, compared with
• New Zealand 2
• Australia 7
• UK 13
• US 19
• When the Clock Starts Ticking, 2006
• The College of Family Physicians of Canada

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What is the Canadian Public saying?

• Canadians want a personal physician, one that
  knows their history and that of their family, and
  one with whom they can build a relationship over
  time - Macleans poll 2003
• Every citizen should be able to name their
  family doctor
• - World Health Organization
• Every Canadian should be able to name their own
  family doctor and Nurse and/or NP
• - CFPC/CNA, Oct 2007

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Were running a little behind, so Id like each
of you to ask yourself Am I really that sick,
or would I just be wasting the doctors time?
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1. Overview

• Improved access reduce waits for appointments
• Improved office flow and efficiency less chaos
• Increased staff, provider and pt satisfaction
  you enjoy coming to work your patients notice
• Improved clinical outcomes better care
• Improved financial outcomes lower cost
• Better use of teams practice full scope

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2. What is AIM?

• Access, Improvement, Measurement
• Improvement process built on existing practice
• Facilitated learning process over a period of 14
  months
• Learning that is based on a set of principles
  that have been tested and have resulted in
  positive outcomes

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3. Why AIM Patients The Canadian health
system is not healthy!(Health Council of Canada,
Dec 2007)

• Hypertension
• One of four adults has HTN, 1/3 dont know it,
  and lt1/3 are controlled
• Diabetes
• 60 of diabetics have gone gt1yr without an
  examination
• Asthma
• Third leading cause of presentation to ER
• Screening
• 38 of eligible women in Alberta get Pap
  screening
• lt10 of those with indications for colon
  screening are screened (CMAJ, 2007)

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3. Why AIM Clinic Access The Canadian
health system is not healthy!(Health Council of
Canada, Dec 2007)

• The single most important issue for Canadians was
  poor access to health care services.
• 79 said the health system in urgently in need of
  fundamental change.
• Delay in seeing a doctor and getting treatment is
  the highest among the seven developed countries.
  
• 25 of Canadians waited gt6 days to see a doctor
  last time they were sick, compared with
• US 19
• UK 13
• Australia 7
• New Zealand 2

When the Clock Starts Ticking, CFPC,
2006 Editorial, Edmonton Journal, Nov 1, 2007.
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3. Why AIM?

1. Positive patient/physician/team relationship
   results in better clinical care/outcomes
2. Patients who do not wait for care are healthier
3. Reliable and predictable delivery results in
   higher quality care
4. Team approach yields improved patient outcomes
5. Culture of improvement creates and sustains
   exceptional clinical care

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4. Components

• Six facilitated learning sessions spread out over
  a 14 month period.
• Action periods following learning sessions to
  test new changes/improvements
• Collection of a series of measures that will
  assist the clinic to make improvement decisions
  based on their individual needs
• Participation in a monthly facilitated call
• Submission of a monthly report to faculty for
  feedback and recommendations

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5. Expectations/Commitment

• Clinic team members will commit to
• Identifying team leaders to support participation
• Being prepared for and attending learning
  sessions
• Having and attending regular improvement team
  meetings
• Participating in monthly teleconference calls
• Collecting data and testing changes
• Contributing to and posting monthly reports
• Communicating with others in the clinic

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6. Getting Started

• Forming your core improvement team
• Those who do the work, need to transform the
  work Dr. Mark Murray
• - Clinic Manager
• - Physician representative(s)
• - Nursing and/or allied health professional
• - Reception representative
• - Medical office assistant(s)
• - Designated improvement lead

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6. Getting Started

• Complete a clinic walk through
• Call in to pre-work teleconferences
• -2 calls 1 ½ hours approximately
• -content on process and measurement
• -scheduled for June, 2009
• Complete clinic profile and submit
• Complete consent for panel request
• Review computer capability
• Prepare storyboard for first Learning Session

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6. Getting Started

• Begin data collection following pre-work call
• - Time to available appointments (TTN)
• - of requests for appointments daily
• (demand)
• - of appointments available daily
• (supply)
• - Time for patient to complete an appt
• through the clinic (cycle time)
• - of patients who fail to keep their appt
• daily (no-shows)
• - of appts. physician actually used
• daily (activity)
• - of patients I would identify as only my
  patients
• (panel)

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6. Getting Started

• Set aims for improvement (goals)
• - Access for an appointment
• How many days should our patients wait
  for an appt ?
• - Efficiency at the appointment
• How long should it take for our patients
  to complete
• a clinic visit?
• - Clinical care outcomes
• Based on the demographics of our
  patients, what
• should our clinical outcomes be?

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6. Getting Started

• Determining roles in process
• -Who attends learning sessions?
• -Who will complete monthly reports?
• -Who will collect and enter data?

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7. Facilitation

• Facilitators will be assigned to each
  participating clinic
• Roles
• - Attend team meetings and learning sessions
• - Assist with pre-work i.e. Clinic walk
  through
• - Participate in monthly calls
• - Assist teams in understanding data
  collection and
• tests of change
• - Provide guidance in monthly report
  content and
• improvement activities
• - Facilitate teamwork

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7. Facilitation

• While facilitators will be a useful resource, the
  following will be the teams responsibility
• - Completing monthly reports
• - Collecting and entering data
• - Presenting team reports at learning
• sessions
• - Making team decisions

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8. Desired Results

• Patient satisfaction improved
• Staff satisfaction improved
• Provider satisfaction improved
• Delays reduced
• Continuity improved
• Quality improved
• Unnecessary visits reduced
• Financial improvement

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9. Actual Results What has been the experience
of others?

• Over 500 physicians and their teams have
  participated so far in AIM
• There have been improvements seen in
• - access for an appointment
• - efficiencies within the clinic that
• have resulted in positive outcomes
• - decrease in overhead costs
• - increase in revenue

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Participant Quotes

• Our clinic is more efficient than it has ever
  been thanks to the great measurement tools and
  support. But the big winner is that we are truly
  a "team" now. Morale is at an all time high.
• - Roxanne Bergheim, Clinic Manager, St. Paul
  Medical Clinic, St. Paul, AB

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Participant Quotes

• My patients now have better access to see me my
  delay measures have been cut in half and that is
  the general clinic trend since we've been
  implementing these strategies.
• - Dr. Rob Wedel, Associate Medical Centre,
  Taber, AB

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Participant Quotes

• Health care is a large and complex system and
  change may often seem overwhelming. AIM provides
  the physician office team with a step-by-step
  approach that can result in significant change
  for the health care team and system, and most
  importantly improves the health of our patients.
• - Sheri Fielding, Nurse Practitioner, Heritage
  Medical Clinic, Edmonton, AB

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For more information or to bepart of Alberta
AIM, contactJulie ShemanchukProgram
Planner1-780-413-5091 (phone)1-780-413-5094
(fax)