Advanced Access & Office Efficiency Learning Session 2 Draft August 16, 2010

2  Agenda  Advanced access key concepts  Share progress & measures from action period #1 › Revelations in some practices  Examine delays within the practice  Introduce and discuss ways to recapture lost capacity within your practice Welcome back!

3

4

5  The care of patients will be redesigned to improve access, capacity and efficiency.  How will the aim be accomplished? Advanced Access, and Office Efficiency change packages will be used to decrease the wait time of patients for, and at, appointments in Primary Care  How will we know this has been accomplished? Change will be evidenced by improved 3rd next available appointment, and improved appointment cycle time. Collaborative Aim

6  Advanced access is “doing today’s work today”  Understand, measure and balance your supply and demand  Reduce your scheduling complexity  Work down your backlog  Develop contingency plans Review of Learning Session 1

7  Tests of change  Successes  Challenges  Measurement Action period report-out Supply

8 “All systems are perfectly designed to get the results they get” - W. Edwards Deming “I had to think about this for awhile before I jumped in. I realized everything in medicine has changed steadily. We are constantly looking for better ways to diagnose and treat patients. But, office flow has stayed the same for 50 year. It is about time we pay attention to it.” - Dr. Patrick Macken, Nephrologist Introduction to Office Efficiency

9 Aim  To reduce delays at an appointment

10  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  Costs/visit are decreased  Income is increased Benefits of Improved Office Efficiency

11  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 Measure of Office Efficiency

12 Registration Patient enters Exam Room Provider-Patient Interaction Completion of procedures/orders Wait Checkout Red Zone Pre-Red Zone Post-Red Zone Cycle time Non-appointment time = Patient flow through the office

13 Registration Patient enters Exam Room Provider-Patient Interaction Completion of procedures/orders Checkout Red Zone Pre-Red Zone Post-Red Zone Cycle time Non-appointment time = Patient flow through the office

14 Measuring cycle time

15 Key Concepts of Office Efficiency  Predict and anticipate care needs ›Streamline work and standardize where possible  Optimize the care team

16 1. Predict and Anticipate Needs Know the work:  Knowing what you do (know your processes)  Knowing how it happens (flow mapping)  Knowing how often it happens (measures)

17 “Know Your Processes” Activity  Each person completes the form  Discuss results with your team  Identify 1-3 areas for improvement  Identify potential strategies  Debrief as a large group You have 20 minutes for this activity

18 Break

19  What is a “process”? › A series of connected steps or actions with an identifiable start and end point › Leads to a specific outcome  Why map a process? › It illustrates “how things work in our practice” › Includes several perspectives › Starting point for improvement Process Mapping

20  Oval - the start and end of the process  Box - the tasks or activities of the process  Diamond - a question is asked; a decision is required  Arrow - the direction or flow of the process Process Mapping

21 Example Steps:  Patient enters room for appt. (start)  Provider enters room  Provider discusses Pt’s needs  Provider examines Patient  Provider IDs need for urine specimen  Patient given specimen cup  Provider completes paperwork  Follow-up instructions given to Patient  Patient leaves (end)

22 Follow-up instructions given to patient Patient leaves Provider completes paperwork Patient given specimen cup Provider discusses patient’s needs Provider examines patient Provider IDs need for urine specimen Patient enters room for appt Provider enters room

23 Process Mapping Activity Please pick one process in your office and map it You have 20 minutes for this activity

24  Where are the hand-offs in the process?  Is it clear who does what?  Where are the delays?  Is there duplication or rework?  Are there identifiable areas where a small change could make an improvement? Table Discussion

25  Who does what?  Who could do what?  Who should do what? 2. Optimize the Practice Care Team

26  Review the measurement tools  Review your schedule  Assess backlog Activity

27  Is pro-active instead of reactive  Knows, trusts, supports and values each other  Communicates with each other, does not feel isolated  Is accountable to each other and to the patient  Uses measures for feedback and to guide improvement The Practice team …

28  A brief (5-10 mins) meeting to: › review schedule › deal with issues left over from previous day › anticipate needs for current day Daily Huddles

29  Reason for visit card  Scripts – greeting, booking, reason for visit  Standardization – checklists, policies, exam room stocks  Interruptions log  Patient experience survey  Track start/end times Other Ideas, Strategies and/or Tools

30 › What are we trying to accomplish? › How do we know change is an improvement? › What changes can we make that will result in an improvement? The Model For Improvement

31 What are we trying to accomplish? How will we know that a change is an improvement? What changes can we make that will result in improvement? Model for Improvement ActPlan StudyDo

32 Where do I start?  What are you going to do next Tuesday?  What is your aim?  Determine how you will measure/track improvement

33  Implement small tests of change  Measure and track  RST support  Continue to work toward your access aim Action Period #2

34 Good Luck!