1 Advanced Access Basics; Demand and Supply Calculations Catherine Tantau Tantau & Associates PO Box 179 Chicago Park, California, ©Tantau & Associates

2 Advanced Access Quick Review…. AA is… No delays for an appointment. CONTINUITY for patients and providers. Doing today’s work today AA is Not… Holding appts in anticipation of same day urgent demand. A Walk in Clinic or Urgent Care Clinic. Telling pts to call back when appts are released.

3 Start with an Aim The Gold Standard Primary Care: Offer an appointment today for any problem (urgent or routine) with the PCP or teammate in the absence of the PCP.

4 Delayed systems… Tension; medical definition, patient definition Waste inherent in tending the delays “If you’re sick and you can prove it.” Pts get in anyway! Delays increase workload. © Tantau & Associates

5 The longer patients wait, The harder we work….

6 RN Work Analysis in a delayed system… Source; CHC, Pacific Northwest, 2008

7 RN Survey “In this office I have the opportunity to do what I do best everyday.” Source; CHC, Pacific Northwest, 2008

8 What is Advanced Access ? NO delays for an appointment. CONTINUITY for patients and providers. Doing today’s work today… So how many appts do we need today?

9 Demand and Supply Equilibrium SupplyDemandDELAY Evidence of a stable reservoir ???

What would Starbuck’s ask??? How many customers / day? What days are busiest? How many lattes? Vs Chai tea vs…??? How many pounds of beans do we need? How much staff do we need to meet daily and hourly variations in demand? What else???? 10

11 Demand Illness Burden of Population Mood and Attitude Continuity Measures: True demand Measures: Panel Size (driver for demand) © Tantau & Associates

12 Demand Look at historical data? True Demand Formula: External Appointment requests, called in and appted regardless of day appted. To (today or future) + Walk-ins for appts. + Other portals of entry ?( , fax,”add-ons” etc.) + Deflections (UCC etc) Internal + Returns booked today for the future © Tantau & Associates Total Demand

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16 Supply Macro Supply…dept level Deployment of Supply…bookable hours Measures Measure when schedule is released. Appts per session for each day of week per provider. Estimate % long and shorts based on prior schedules Hours per session ? Productivity standard? Office FTE modification Process of Supply… What is the work? Who does the work? What can we try doing differently?

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Tracking Demand and Supply source: YKHC, Bethel Alaska

Activity; the 3 rd Dimension Activity is the measure of patients who were actually seen today. At the end of the day, regardless of demand or supply, count the number of patients seen. Accounts for No Shows. 20

21 Three Dimensions; Demand, Supply, Activity

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23 The latest… Demand, Supply, Activity A three dimensional look at what’s really going on in the practice. Source: Huron Gastro, Ann Arbor

24 Demand… Scheduled Supply….. Available Activity…..Patients seen

25 How to Track… How long to track… Tic Marks vs Electronic tracking 4-6 weeks and then forever Separating Internal from External © Tantau & Associates

26 What’s your situation? How do you know? D>S ? D<S ? D:S ? “Our schedules are jammed every day. Our Demand must outstrip our Supply”(??????) “We’ve had the same Delay for months.” “We measure D and S, continuously and map the trends.”

27 Show and Tell Teams share their data Ask questions Discuss next steps

28 If Demand is Greater than Supply Four Options 1. Work harder ? 2. Delay the work ? 3. Buy more supply ? 4. Do the work differently !!! …test…. Shape Demand Eliminate duplicate visits Care Team development; leverage the work Extend visit interval Promote Continuity Max Pack Simplify Appt types and times Nurse Appts Phone Appts Improve Access to reduce No Shows and capture that Supply Spread

29 Identify source of demand and ask, “Why?” Internal External Discontinuity Single issue visits to ramp up visit count? Bumping Delays and defensive booking Sub-optimized Care Team Growth

30 Try something New! Test, test, test…

31 Critical Access Design Elements 1. Continuity / familiarity 2. Appointment capacity 3. Demand and Supply equilibrium