The UCSF Double Helix Curriculum: Facilitator Guide Time: 20 minutes Audience: 1st – 3rd year residents Objective(s): Understand how patient access for different care needs (same-day, acute, preventative, chronic care follow up, etc) can be tracked over time, and how to use this data to innovate systems to meet these needs Transformation of High-Performing Primary Care in Education The UCSF Double Helix Curriculum:

How to Measure and Interpret Access Adapted from the Center for Excellence in Primary Care

The UCSF Double Helix Curriculum: Key Measures Metric Definition What to Look For % Same Day Appointments # of appointments that were scheduled the same day / # scheduled appointments Meeting same day ratio targets % open capacity # open slots / # appointments available There are enough appointments in the future to continue to book into 3rd Next Available # days until 3rd open appointment Should be =< 1 Transformation of High-Performing Primary Care in Education The UCSF Double Helix Curriculum:

Appointment Scheduled The UCSF Double Helix Curriculum: Same Day Appointments Clinic Schedule Appointment Scheduled 1:00 PM HUDDLE 1:20 TODAY 1:40 2 weeks ago 2:00 2:20 1 month ago 2:40 3:00 Yesterday Transformation of High-Performing Primary Care in Education The UCSF Double Helix Curriculum:

The UCSF Double Helix Curriculum: Future Open Capacity Identifies if the next 2 weeks/month/etc. has needed availability Tracking this data helps to forecast scheduling and balancing of time off requests. Data shows the total number of slots a provider has during a specified time period, how many are filled and how many are available. Transformation of High-Performing Primary Care in Education The UCSF Double Helix Curriculum:

The UCSF Double Helix Curriculum: Future Open Capacity Week This week Next Week 3 Weeks 4 Weeks # Open 2 10 25 45 Total Appointments Available 50 Transformation of High-Performing Primary Care in Education The UCSF Double Helix Curriculum:

The UCSF Double Helix Curriculum: Future Open Capacity Week This week Next Week 3 Weeks 4 Weeks # Open 2 10 25 45 Total Appointments Available 50 Transformation of High-Performing Primary Care in Education The UCSF Double Helix Curriculum: 82 200 = 41% Future Open Capacity:

The UCSF Double Helix Curriculum: Strategies to Improve Meet with schedulers. Are same day appt declining and being used for pre-books/follow ups? Lengthen return intervals Is face to face follow up necessary or can it be done over the phone or by another team member? Look at demand—do you need to increase or decrease same day ratio? Transformation of High-Performing Primary Care in Education The UCSF Double Helix Curriculum:

Third Next Available Appointment “How long does our patient need to wait for an appointment?” Transformation of High-Performing Primary Care in Education The UCSF Double Helix Curriculum:

Third Next Available Appointment Day of the Week Mon Tues Wed Thur Fri Sat Sun Open/Scheduled Appointments X 3rd Next Available Measure 1 2 3 4 5 6 7 8 Transformation of High-Performing Primary Care in Education The UCSF Double Helix Curriculum:

Third Next Available Appointment Day of the Week Mon Tues Wed Thur Fri Sat Sun Open/Scheduled Appointments X 3rd Next Available Measure 1 2 3 4 5 6 7 8 Transformation of High-Performing Primary Care in Education The UCSF Double Helix Curriculum:

Third Next Available Appointment Day of the Week Mon Tues Wed Thur Fri Sat Sun Open/Scheduled Appointments X 3rd Next Available Measure 1 2 3 4 5 6 7 8 Transformation of High-Performing Primary Care in Education The UCSF Double Helix Curriculum:

The UCSF Double Helix Curriculum: Strategies to Improve Evaluate daily use of appt schedules with staff. Are same day appts slots being used appropriately? Evaluate provider availability per demand needs (ie days scheduled) Contingency plans for vacation, leave, illness Transformation of High-Performing Primary Care in Education The UCSF Double Helix Curriculum:

Creating Capacity Today Simple Way Create a “drop dead” date Block appointments for same/next day access Alternative Way Bring in additional supply in order to start meeting pent up demand Transformation of High-Performing Primary Care in Education The UCSF Double Helix Curriculum:

Deciding on How Much Capacity to Reserve Understand your data! Transformation of High-Performing Primary Care in Education The UCSF Double Helix Curriculum: # of people who call today for an appointment # of appointments per day

Communicating to Patients Transformation of High-Performing Primary Care in Education The UCSF Double Helix Curriculum:

Communicating to Staff Role Training All Staff Reason for this work in this clinic Overview of the new model How patients will be informed Front Desk/ Schedulers New scheduling guidelines Communicating with patients about the changes (scripts) Managing requests for appointments when there are no appointments left Clinical Support Staff Tracking patients who do not need follow up appointments Communicating with patients about the changes Managing requests for appointments when full PCPs Deciding who needs a follow up appointment Communicating with patients about the schedule Understanding scheduling data Transformation of High-Performing Primary Care in Education The UCSF Double Helix Curriculum:

The UCSF Double Helix Curriculum: Key Principles Bring the point at which supply and demand is balanced closer to today Use the schedule for scheduling – not for tracking patients Communicate, communicate, communicate – both to patients and to staff Follow the data Transformation of High-Performing Primary Care in Education The UCSF Double Helix Curriculum:

The UCSF Double Helix Curriculum: Evaluation Transformation of High-Performing Primary Care in Education The UCSF Double Helix Curriculum: See evaluation sheet for thread objective