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

Overview 1.What is AIM? 2.Why AIM? 3.Components 4.Expectations of Participation 5.Getting Started 6.Facilitation 7.Desired Results 8.Actual Results

1.What is AIM? Access, Improvement, Measurement Improvement process built on existing practice realities Facilitated learning process over a period of approximately 8-14 months depending on delivery model Learning is based on a set of tested principles that have resulted in positive outcomes

2.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 <1/3 are controlled Diabetes 60% of diabetics have gone >1yr without an examination Asthma Third leading cause of presentation to ER Screening 38% of eligible women in Alberta get Pap screening <10% of those with indications for colon screening are screened (CMAJ, 2007)

2.Why AIM – Patients: 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 >6 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.

2.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

3.Components facilitated learning sessions spread out over a 8-10 month period. Action periods following learning sessions to test new changes/improvements Collection of a series of measures to assist clinics in making improvement decisions based on their individual needs Participation in facilitated, collaborative teleconferences Submission of written reports to faculty for feedback and recommendations

4.Expectations/Commitment Clinic team members will commit to: Identifying team leaders to support participation Preparation and attendance at all learning sessions Having and attending regular improvement team meetings (recommended weekly) Participating in all teleconferences Collecting data and testing changes Contributing to and posting written reports Communicating with others in the clinic

5.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

5.Getting Started Complete a clinic walk through Call in to pre-work teleconferences or attend pre-work half day workshop Complete clinic profile and submit Complete consent for panel request Review computer capability Prepare storyboard for first Learning Session 10

5.Getting Started Begin data collection following pre-work Time to third next available appointments (TNA) # of requests for appointments daily (Demand) # of appointments declared available daily (Supply) # of appointments actually seen daily (Activity) Time for patient to be seen at the appt. from arrival to departure (Cycle Time) # of patients who fail to keep their appt. daily (No- Shows) Primary Care # of patients doctor would identify as only their patients (Panel) Specialty Care / Programs # of patients service / program would identify as only their patients (Caseload)

5.Getting Started Set measurable, time sensitive aims for improvement What is our goal? By when? Access for an appointment – How many days should our patients wait for an appointment? Efficiency at the appointment – How long should it take for our patients to complete a clinic visit? Clinical care outcomes –Based demographics, what clinical outcomes goals will we strive for? 12

5.Getting Started Determining roles in process: Who attends learning sessions? Who will complete monthly reports? Who will collect and enter data? 13

6.Facilitation Facilitators are assigned to each participating clinic Facilitators act as extensions of faculty to provide coaching, resources and assistance to teams Facilitator task – examples Attend team meetings, teleconferences and learning sessions Assist with pre-work i.e. Clinic walk through Assist teams in understanding data collection, and tools Provide guidance in written report content and improvement activities including test of change Facilitates teamwork as required and requested

6.Facilitation While facilitators are 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

7.Desired Results Patient satisfaction improved Staff satisfaction improved Provider satisfaction improved Delays reduced Continuity improved Quality of clinical care improved Unnecessary visits reduced Financial improvement Overall system improvement

8.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 17

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

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

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

For more information or to be part of Alberta AIM, contact: Julie Shemanchuk Alberta AIM Program Manager Phone: Fax: