(Your Name)

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• New Practices and Providers in Primary Care
• Advanced Access Efficiency

(Your Name) QIC Health Quality Ontario
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Objectives

• To understand
• how the principles of Advanced Access and
  Efficiency relate to new providers/practices
• how the Panel Size Equation can be used to
  monitor and stay in balance
• how to use data to inform the work

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Overview of Advanced Access and Efficiency in New
Primary Care Practices
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Who are we and what do we do?

• Give the patient an appointment when they want or
  need one
• AND
• See your own and dont make them wait
• AND
• Do todays work today
• 
  Mark Murray M.D.

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Principles of Access

1. Understand and Balance Supply and Demand
2. Increase Supply
3. Decrease Demand
4. Reduce Appointment Times and Types
5. Reduce Backlog
6. Develop Contingency Plans

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Principles of Efficiency

• Balance supply and demand for non-appointment
  work
• Synchronize patient, provider, information,
  rooms, equipment
• Predict and anticipate patients needs
• Optimize rooms, staff and equipment
• Manage constraints

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The Panel-Size Equation

• Supply ( Weeks worked/year) X (
  appointments/week)
• MUST EQUAL
• Demand ( of pts/clients in pane)l X (visit
  rate)

S
D
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The Panel-Size Equation (an example)

• Supply (Weeks worked/year) x (appts./week)
• 46 x
  92 4232
• Demand (Panel Size) x (visit rate)
• 1200 x
  3.5 4200
• This is an example of a balanced practice

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Visit Rate Calculation Example

• In a practice where
• Weeks worked 45
• Appts./week 105
• Panel Size 1000
• 45 x 105
  4.7 visit rate
• 1000

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Electronic Medical Records

• Give extra attention and careful consideration to
  data entry
• Do not assume that everyone is using the same
  operational definitions
• Standardize the way things go into the database
  to make retrieval easier
• Is it DM? DMT2? DMII? or some other variation?

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Things to Consider

• Clinic hours of operation (especially if
  part-time)
• If possible, spread available time across week
• Dont bunch time at beginning or end of week
• Example for 3 days in office consider Monday,
  Wednesday, Friday instead of Mon, Tues, Wed

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Three Moving Parts

1. Everyone is getting used to the new system and to
   each other
2. New patients require more time at an intake appt.
3. New patients will generate more follow/ups
   initially so visit rate will start out higher

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Scheduling Strategies during Rostering

• Book every other appointment allows
  enough time for each new patient
• After awhile use in-between slots with F/Us as
  they will require less time
• Once closer to target, reduce number of slots
  required daily for new patients

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Begin to Measure

• Each week
• Measure the ratio of New Patients/Clients Return
  Follow/ups
• This will give an indication during initial phase
  how many return visits are generated by new
  patients/clients

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Team Roles

• Maximize all team members scope of
  practice
• Involve everyone in rostering process
• Decide prior to taking on patients/clients what
  each team member will do

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Team Roles (cont.d)

• Be flexible and revisit roles often at team
  meetings
• Be open to what is working and what is not
  working
• Consider morning and/or afternoon huddles to
  reduce interruptions and increase readiness
  for appts.

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What About Wait Times?

• Monitor Third Next Available (TNA)
• Wait times will fluctuate during rostering
  due to variables mentioned earlier
• New system, new staff
• New patients/clients take more time
• New patients/clients generate more follow ups
• Wait times will stabilize closer to end of
  rostering process if balance in equation is
  maintained
• Wait times will stabilize towards end of
  rostering process if balance in equation is
  maintained

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Continue to Measure

• TNA for
• new patients
• return visits
• Based on info have strategy if wait passes 5
  days, 10 days, etc
• As a team ask yourselves How could the schedule
  be reworked?

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Principles of Efficiency

• Create process or flow maps of various office
  processes
• e.g. routine patient appointment, chronic disease
  visit, well baby check up, prescription renewal,
  etc
• Decide as a team how and when non-appt
  work will be handled
• e.g. med refills, forms, lab reviews, etc
• Review processes often and refine as needed
• Test different ways of doing things before
  implementing permanently

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Example of a Process Map (during)
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Example of a Process Map(After)
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Appointment Lengths

• As a team decide on a basic appointment length
• 10 mins, 15 mins, 20 mins, 30 mins?
• Make all appointments multiples of the
  basic appt.
• An example
• Regular appointment 15 mins
• Chronic Disease F/U 30 mins (i.e. 2 x 15)
• Annual Physical 45 mins (i.e. 3 x 15)

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Consider Patient Input or Feedback

• How will it be obtained?
• Who will review
• What to do with the information/data?
• Methods
• Satisfaction surveys (sampling)
• Clinic Walkthrough (Through the eyes of the
  patient)
• Practice Assessment (5 Ps Purpose, Patients,
  Processes, Professionals, Patterns

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Contingency Plans

• Discuss as a team
• Develop time-off policies for vacations,
  conferences, etc prior to needing them
• Decide how to handle various events that could
  affect supply of appointments required for
  patient/client demand
• Reduce need to make decisions on the fly

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Will it Ever Get Better?

• By 6 to 9 months depending on rate of intake
• Variation and number of new patients will
  decrease
• Understanding of panel size, demographics and
  acuity will increase
• Return rate will stabilize and can be better
  understood

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Tips and Critical Success Factors

• Clear aim with an endpoint
• Consistent approach of how to get there
• Committed Leadership
• Engage the people who do the work
• Test before implementing
• Celebrate the victories along the way
• Measure, measure, measure

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In Summary
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Resources
Based on work by Dr. Mark Murray and Associates
- MMA
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• www.HQOntario.ca