1. Dr John Oldham OBE

2. The Cycle of Fear Increase Fear Micromanage Messenger Information
Kill the
Messenger
Micromanage
Filter the
Information
©John Oldham 2002

3. Every system delivers exactly the results it is designed to give
©John Oldham 2002

4. Diffusion of Innovation
35%
Early Majority
35%
Late Majority
13%
Early Adopter 2%
Innovators
15%
Laggards
©John Oldham 2002

5. Collaborative Process
An improvement method that relies on spread and adaptation of existing knowledge to multiple settings to accomplish a common aim.
It is not:
A research project for new knowledge
A set of conferences
A passive exercise
©John Oldham 2002

6. Collaborative Process
Select Topic Participants
Planning Group
Identify Change
Concepts P P A D A D S S
Pre work
LW0
LW1
LW2
LW3
Support
Project Managers
Phone
Discussion Group Assessments
Access to expertise Peers
©John Oldham 2002

7. Collaborative Culture
Respect
Group learning and rapid doing
No blame
Flexibility - ideas - methods
Firm on results
©John Oldham 2002

8. Fundamental questions for improvement
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 an improvement?
©John Oldham 2002

9. Model for improvement Act Plan Study Do
rationally on results for next cycle
the test
execute it
on results
©John Oldham 2002

10. Example of a PDSA Cycle Plan
2 doctors on Tues and Thurs evening after surgery to call list of identified patients with advance booked routine appointments to determine if the routine appointment is still necessary. Start 13th June. Do
Carried out 13/15/20/22 June
©John Oldham 2002

11. 15% appointments could be cancelled.
Study
15% appointments could be cancelled.
Some telephone numbers not updated, some patients no telephone, language problems.
Required minutes consultation time.
High patient satisfaction.
Act
Timetable the telephone consultation in on Tues/Thurs evenings
Extend to 3 doctors
Assess non-contact rate
©John Oldham 2002

12. Repeated Use of the Cycle
Theories Testing changes Changes resulting in
improvement
A P
S D
D S
P A
A P
S D
DATA
A P
S D
©John Oldham 2002

13. Advanced Access in Primary Care

14. Why?

15. “Every system delivers exactly the results it is designed to give”

16. 30 30 30 30 30 Day Mon Tues Wed Thurs Fri
Max no of avail
appointments
Daily Demand
Blocked urgent for the day
Filled routine
Free routine
©John Oldham 2002
© John Oldham 2001

17. 30 30 30 30 30 Day Mon Tues Wed Thurs Fri
Max no of avail
appointments
Daily Demand
Blocked urgent for the day
Filled routine
Free routine
©John Oldham 2002
© John Oldham 2001

18. Reservoir Wait Times Demand Supply DNAs 10days Efficiency Rework
Mark Murray
©John Oldham 2002

19. In order to protect tomorrow, we pull work into today.
Paradigm Shift
Old
In order to protect today, we push work to tomorrow.
New
In order to protect tomorrow, we pull work into today.

20. The Fears
Schedule Saturated
Demand is Insatiable

21. Components of Advanced Access
Understanding profile of demand
Adjusting the handling of demand
Matching capacity to demand
Contingency plans
Communicate,communicate
©John Oldham 2000

22. Understanding the Profile of Demand

23. What is current daily demand?
Any request for any type of appointment on a single day i.e. includes appointments for doctors and nurses for investigations and consultations.
It includes all requests made on that day WHETHER FOR THE SAME DAY OR A FUTURE DAY.

24. How do we measure current daily demand?
Count by tick box (e.g. as per demonstration sheet) each day for 5 days.

25. Demonstration tick sheet
Appt Mon Tues Wed Thurs Fri Total
with/for (wk)
Doctor ////
////
F-ups ///
Nurse ///
Practitioner
F-ups
Practice ////
Nurses

26. Changing Demand

27. Responding to demand
©John Oldham 2002

28. Some Examples of Changing Demand
Telephone follow-up reduces face-to-face consultation by 15-20%
Telephone management of same day requests reduces consultation by 30-50%
Advanced access reduces non-attenders by 50%
consultation/queries
Reduce follow-ups on Mondays
©John Oldham 2000

29. Chronic Disease Management Self-help
Number % List % Variation
against HA
average
Total number
with asthma
Those with
Asthma receiving:-
Prophylactic
Medication
Self Management
Plans n/a
Admitted to hospital
©John Oldham 2000

30. Matching Capacity to Demand
Work down backlog
Anticipate associated needs
Match team to work
who does it now
who could do it
what is the next step

31. Contingency Plans
Holidays
Training
Sickness
Epidemics

32. Free appointments Pre-bookable follow ups Day Mon Tues Wed Thurs Fri
Max no of avail
appointments
Daily Demand
With adjusted
Handling of
demand
Free appointments
Pre-bookable
follow ups
©John Oldham 2002

33. ©John Oldham 2002

34. ©John Oldham 2002

35. Dissatisfaction with life as you know it
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
Match capacity to demand
Work down the backlog
STEP 5
Put contingency plans in place