1. Join the conversation! Our Twitter hashtag is #CPI2011. Advanced Access Scheduling: They said it could not be done in a Residency Program! Dr. Michael O’Dell, MD, MSHA Chairman, Community and Family Medicine UMKC School of Medicine Shelly Phinney, MBA, Lean Six Sigma Black Belt Director, Community and Family Medicine

2. About us… Located in Eastern Jackson County, Missouri Limited access to public transportation Hospital Based 38 Family Medicine Residents 25 Faculty 3 Fellowship Programs

3. TMC Lakewood - –96,000 outpatient visits a year –30,000 emergency room visits a year –1000-1200 deliveries a year –103 licensed beds –212 long term care beds About us…

7. Access and Scheduling Project Team Nursing Residents Faculty Scheduling staff Contact Center staff Financial Counseling Center Registration

8. Current State One Year Ago All appointments booked No room for acute care or patient preference Some providers over their capacity due to “compassionate” over-booking No show rate 25% plus

9. What did we want to accomplish? Provider capacity approximating 100% Improve provider satisfaction Improve patient access and satisfaction with access Reduce ED visits

10. “Responsive” Scheduling- Meets patient and provider needs Same day appointments are not for “acute” care only Should flex according to seasons

11. Goals- Increase the number of same day appointments to accommodate patient demand and improve patient satisfaction. Decrease the over all no-show rate to 9%. Increase volumes.

12. Breaking down Barriers for our patients… Simplified scheduling guidelines for Family Medicine Educated staff, faculty and residents Added more resident clinics Created scripting for schedulers

13. Breaking down Barriers for our patients… 25% same-day appointments in the FMC beginning January 2011. Talked with Missouri Medicaid about transportation issues. Met with Emergency Room Staff.

14. Metrics Same-Day Access Metrics Same-day appointments available start of day Same-day appointments not filled each day Number of patients opting to call back to see their physician Number of patients opting to schedule further out to see their physician Number of patients who opted to see a different physician No-show rate Press Ganey Score- access to care questions

18. Challenges- Silos and distrust among the team. Residents fear of being overwhelmed. Difficulty getting schedulers to understand the concept and stay within guidelines.

19. Challenges- A team approach to care- a complete change in mindset (transfer of care versus new patient) Administration’s confusion with capacity versus access Excessive panel sizes

20. How cool is this? The panel walk-in clinic “went away”. Nursing staff was reallocated to “Patient Traffic Controller”. Residents in walk-in clinic reallocated to new “Access-based care rotation”. Increase in direct admits from clinic. A shift from seeing only chronic patients to seeing patients with more “urgent” needs Flexibility when there are staffing issues

21. George- our PTC (Patient Traffic Controller”)

22. Lessons Learned Residents start to look at their schedules ahead of time. You must monitor schedules daily and give staff feedback daily. Ask schedulers “How is it going?”often and make changes quickly. Our patients were not ready for same-day access. Schedule a same-day at the beginning of the session.

23. Lessons learned… Continuity of care was not lost! Resident work loads become easier. Create a plan for OB patients. Regular meetings with the team is important. Open door policy for “This is not working”. Never give up!

24. Next steps- Rapid Cycle Improvement Smaller teams Redefining roles Nursing protocols Population management Patient portal

26. Questions?