Advanced Access What can we accomplish in Leader? November 2004

What is Advanced Access? A way to improve patient access in general practice by ensuring a balance between demand for services and the capacity of the practice to deliver them Helps practices to understand the size and nature of the needs of patients, and how to develop services to effectively meet them Put the practice in control of their workload

How Does it Work? Step 1: Dissatisfaction with life as you know it Step 2: Understand the demand each day of a typical week Step 3: Shape the handling of demand Step 4: Working down the backlog by matching capacity to demand Step 5: Put contingency plans in place

Step 1: Dissatisfaction with Current System Overworked Frustrated Never caught up Stress

Step 2: Understanding Demand Simply understanding how many people wish to be seen at the practice Data collection for demand is straightforward

Step 3: Shape How Demand is Handled Alternatives to face-to-face consultations Telephone follow-ups ? – not likely… Referral to other professionals Nurse Practioner Public Health Dietitian Pharmacy Home Care Etc.

Step 4: Working Down the Backlog Most difficult part of achieving Advanced Access Short periods of intense hard work by the practice team – but long-term benefits are well worth it

How Do We Work Down Backlog? Distinguish between “good” and “bad” backlog “Good” = pre-booked appointments, follow-up appointments “Bad” = patients that have been pushed to a future appointment because no appointments are available on the day they want to be seen Bad backlog must be cleared to achieve Advanced Access

How Do We Work Down Backlog? Calculate the number of appointments that need to be cleared to work down bad backlog We’ll have help to do this! Decide on best way to clear backlog Decide as a practice team

Possible Ways to Clear Backlog… Add a few extra appointments onto each physicians’ schedule for limited time Agree to no meetings or days off during “clearing” time Run clinic for extended hours for limited time Locum coverage

Step 5: Contingency Planning Necessary for times when physicians are away or demand is unusually high Holidays, Flu season, etc.

Contingency Planning 3 steps will help in understanding what happens when capacity is reduced Step 1: Calculate total number of appointments lost when physician(s) is away Step 2: Link this information to your knowledge of daily demand to determine affect Step 3: Identify ways to handle loss of capacity

Ways to Plan… Handling demand in different ways Adding appointments to remaining physicians’ schedule No pre-booked appointments for first few days of physicians’ return Locum coverage

Where Can We Start? Step 2 – Understanding the Demand Baseline data collection Surveys measuring patients’ baseline perception Given to patients as they leave the clinic Approved by HQC

Measuring Baseline Demand Every day for a week, receptionists record the total appointment requests in the practice (usually done for ~4 weeks) Includes telephone, walk-up, and follow-up requests Identify follow-up appointments separately Recorded on a “tick” sheet Extremely simple to do

Look For the Patterns Baseline data allows us to understand the scale of total demand for appointments Helps to understand the variation that occurs on different days of the week Generally demand is high on Monday, tapers off until Thursday, then rises again on Fridays

Some Challenges We’ll Face? On-call physician No pre-booked appointments? Working down the backlog Done when locums are already scheduled Dr. Koobair’s return Nurse Practioner’s arrival Eatonia days Look at demand patterns on Tuesdays & Fridays

Benefits Physicians more in control of their workload Practice staff are less stressed Patients are happier Decrease in out-of-hours patient visits Decrease number of DNAs (Do Not Appear)

Support We have support from the Saskatchewan Health Quality Council A couple of other sites throughout the province (rural and urban) are also looking at implementing Advanced Access

Quotes Physician: “We’ve certainly seen a huge increase in clinician satisfaction. I myself have found surgeries [clinics] much more acceptable, I feel much less stressed, much less hassled, I feel I’m actually giving much better patient care”. Receptionist: “I’ve worked here for 15 years; the two weeks since we introduced advanced access have been the best of my working life”.

“Every system is perfectly designed to deliver the results it gets… Pushing the old system harder won’t work, creating more of the old system won’t work, thinking differently does”