Advanced Access/Office Efficiency PSP master PowerPoint template specifications Font throughout: Myriad Pro Title font colour: RGB 220 102 30 All text font colour: RGB 76 89 89 Title and ending slides: Title: 44 font Speaker: 32 font Place and date: 20 font Content slide (positions from top left corner): Title: 32 font; title text box: horizontal 0.56” vertical 0.25” Main text box: horizontal 0.56” vertical 0.25” Footnote: 12 font; horizontal 0.56” vertical 7.25” Font sizes and bullets: see slide 2 PSP logo: horizontal 9.23” vertical 7”; size = height 0.75”, width 1.74” Page number: horizontal 10.39” vertical 7.67” Position of graphics and text from top left corner: Top graphic: horizontal -.01” vertical 0.12” (short orange and long taupe) Bottom graphic: horizontal 0” vertical 8.08” (long taupe and short orange) PSP logo: horizontal 1.06” vertical 1.17” ‘ size = h 1.29” w 3” Master title: horizontal 0.56” vertical 3.5” Speaker: horizontal 0.56” vertical 5.08” Date and place: horizontal 0.56” vertical 5.92” Information box: horizontal 1.64” vertical 3.17” MOH / BCMA logos: horizontal 6.72” vertical 7.04”; size = h 0.71” w 2.5” – must be on title and ending slides GPSC / SSC / Shared Care logos: horizontal 3.46” vertical 5.83”; size = h .66” w 4.82” – must be on last/ending slide PSP website URL pspbc.ca: horizontal 1.06” vertical 7.17”; size = h .39” w 3” – must be on title and ending slides Advanced Access/Office Efficiency Learning Session 2 Presenters name here Location here Date here

Faculty/Presenter Disclosure Speaker’s Name: Speaker’s Name Relationships with commercial interests: Grants/Research Support: PharmaCorp ABC Speakers Bureau/Honoraria: XYZ Biopharmaceuticals Ltd Consulting Fees: MedX Group Inc. Other: Employee of XYZ Hospital Group Please fill out all applicable areas (highlighted in red). One slide per speaker.

Disclosure of Commercial Support This program has received financial support from [organization name] in the form of [describe support here – e.g. educational grant]. This program has received in-kind support from [organization name] in the form of [describe the support here – e.g. logistical support]. Potential for conflict(s) of interest: [Speaker/Faculty name] has received [payment/funding, etc.] from [organization supporting this program AND/OR organization whose product(s) are being discussed in this program]. [Supporting organization name] [developed/licenses/distributes/benefits from the sale of, etc.] a product that will be discussed in this program: [enter generic and brand name here]. Please fill out all applicable areas (highlighted in red).

Mitigating Potential Bias [Explain how potential sources of bias identified in slides 1 and 2 have been mitigated]. Refer to the College of Family Physicians of Canada’s “Quick Tips” document. Please fill out all applicable areas (highlighted in red). Please visit the following link for the CFPC’s “Quick Tips” document: http://www.cfpc.ca/uploadedFiles/CPD/Mainpro_-_Maintenance_of_Proficiency/QuickTips_COI_Final_ENGLISH.pdf

Some info A few housekeeping items: cells, washrooms. We know emergencies sometimes come up, please feel free to leave the room if you need to take a call The agenda is on the table in front of you. Of importance you will note we are having a break for coffee around: (time) Housekeeping washrooms and nearest fire exist Ground rules Respect all ideas and opinions Share experiences with your peers On time back from break Cell phones on mute or vibrate?

At the end of today’s session participants will: Be able to understand Advanced Access and how it can benefit their practice. Understand a proven evidence-based process for implementing small, but significant innovations to improve access. Have a plan for implementing these changes into their practices over the next few months.

Practice Support Program (PSP) Sustainability Support LS1 AP1 LS2 AP2 LS3 Learning sessions Peer-led learning, team based approach Periods between Learning Sessions work with PSP Support Leaders to implement changes into practice Action Period Created through a tripartite agreement with the Ministry of Health, the BCMA, and the Health Authorities Based on feedback from the GPs: Trained, Supported. Paid Supports GPs and their practices to integrate new ways of doing things into their practices Goals: -Improve access for patients to guideline-based care -Improve physician satisfaction -Make family practice a more attractive option to graduating physicians Current modules = Chronic Disease Management Group Visits/Patient Self-Management/Health Literacy Advanced Access Mental Health End of Life Upcoming modules = CYMH MSK OPUS Hollander surveys baseline and post. Session evaluation and sustainability surveys Evaluations

Agenda Welcome Stories from Action Period 1. Office efficiency - why is it important? Current office challenges. Small group breakouts - Solution Centres. Next steps…

Your stories from Action Period 1 Open phone lines early Schedule grooming Tracking reason for visit Four questions

Office Efficiency Why is this important? Scenarios: The laundry list of complaints Going in blind to the appointment Phone ringing off the hook while patients line-up My clinic day ended two hours ago

Benefits of Improved Office Efficiency Appointments start and end on time. Work days start and end on time. Office visit is optimized; patient-provider time protected. Rework and duplication of work is decreased, thereby increasing capacity. Experience of patient, staff and provider is improved Income is increased. 11

Collaborative Measures Delay for appointment Cycle times Patient experience – Access Patient experience – Office efficiency Provider and staff experience Review of Measures for concepts learned in LS1 These are the measures for success in this work. The context and what specifically will be measured will be introduced shortly. You will use this information to determine whether the changes you will make have made the difference that you intended. It is very important to keep in mind that measurement is for improvement, and not for judgment. You are all starting with different delays, different processes, and will have different practice level aims. You measure to see the starting point, and how you are progressing.

Measure of office efficiency Cycle time. From time of “check-in”, until time of “check-out”. Gain insight into possible bottlenecks in practice processes. Assess your practice, from patient’s perspective. Review of LS1 concepts Cycle Time is the measure of the time taken for the appointment, including all unnecessary delays. It is the time from “check-in” to “check-out”. Therefore this is used to gauge improvements in office efficiency What is actually being measured is total time with physician, staff, non-physician time, and waiting. NB: There is no “ideal” cycle time. Rather it is dependent on the patients and the practice style. However, the goal should be to maximize the value which means getting rid of “waits” and delays in the appointments. Why measure patient cycle times? Gain insight into possible areas of improvement in practice processes Help assess your practice – from patient’s perspective From a practice and patient perspective, there is value added time, and non-value added time Again, the goal is to optimize the value added time, i.e. time with the provider, and decrease non-value added time Method of tracking One option is to use a cycle time tracker, and sample throughout a day for each provider. First and last appointment of the am and pm, plus one more in the middle of the morning for instance (5 total), and on one day of the week to start. Have the patient keep track, with the initial times filled in by the MOA, or have someone shadow the patient and keep track. Covers from time of “check- in” until time of “check-out” (don’t worry about patients who arrive early, as the actual scheduled appointment time is noted on the sheet) Those of you with an EMR may be able to use it to capture some of the information (Advise participants that their package includes an information sheet about cycle time, as well as a blank template of the survey.) 13

Patient Survey Example of Patient survey

Sharing Current Office Challenges Large group facilitated Discussion Share what your office has tried out. How did it go? What did you learn? What challenges were there? What surprised you?

Small Group Breakout: Solution Centres Find a topic that resonates with you. Limit of seven people per table. Three rotations of 25 minute discussions. Facilitator at each table will remain there throughout each rotation. Participants move to next topic when time to rotate. Cannot find your challenge - start a topic. One 25 minute rotation before break

Breakout discussion questions: Rotation 1 One 25 minute rotation before break

Break… 18

Small Group Breakout: Solution Centres Find a topic that resonates with you. Limit of 7 people per table. 3 rotations of 25 minute discussions. Facilitator at each table will remain there throughout each rotation. Participants move to next topic when time to rotate. Can’t find your challenge- start a topic. Two 25 minute rotations after break

Breakout discussion questions: Rotation 2 One 25 minute rotation before break

Breakout discussion questions: Rotation 3 One 25 minute rotation before break

Where do I start? What are you going to do next week? What is your goal? Determine how you will measure/track improvement. So, what are you going to do next week – to start small steps of change in your practice? What is your overall aim? How are you going to track and measure as you embark on making changes?

Action period planning tool

A few more things… Please complete and submit: Session evaluation form. Action period form with follow up visit date.

Next Learning Session Date Please make a note of the date of the next learning session – evening session, same format to be expected. Thanks to the physician facilitators for their leadership in this module. Again, we at PSP are here to support you and coach you each step of the way.

Practice Support Program For more information Practice Support Program 115 - 1665 West Broadway Vancouver, BC V6J 5A4 Tel: 604 736-5551 www.pspbc.ca