1. Advanced Access/Office Efficiency
PSP master PowerPoint template specifications
Font throughout: Myriad Pro
Title font colour: RGB
All text font colour: RGB
Title and ending slides:
Title: 44 font
Speaker: 32 font
Place and date: 20 font
Content slide (positions from top left corner):
Title: 32 font; title text box: horizontal 0.56” vertical 0.25”
Main text box: horizontal 0.56” vertical 0.25”
Footnote: 12 font; horizontal 0.56” vertical 7.25”
Font sizes and bullets: see slide 2
PSP logo: horizontal 9.23” vertical 7”; size = height 0.75”, width 1.74”
Page number: horizontal 10.39” vertical 7.67”
Position of graphics and text from top left corner:
Top graphic: horizontal -.01” vertical 0.12” (short orange and long taupe)
Bottom graphic: horizontal 0” vertical 8.08” (long taupe and short orange)
PSP logo: horizontal 1.06” vertical 1.17” ‘ size = h 1.29” w 3”
Master title: horizontal 0.56” vertical 3.5”
Speaker: horizontal 0.56” vertical 5.08”
Date and place: horizontal 0.56” vertical 5.92”
Information box: horizontal 1.64” vertical 3.17”
MOH / BCMA logos: horizontal 6.72” vertical 7.04”; size = h 0.71” w 2.5” – must be on title and ending slides
GPSC / SSC / Shared Care logos: horizontal 3.46” vertical 5.83”; size = h .66” w 4.82” – must be on last/ending slide
PSP website URL pspbc.ca: horizontal 1.06” vertical 7.17”; size = h .39” w 3” – must be on title and ending slides
Advanced Access/Office Efficiency
Learning Session 1
Location
Date

2. Faculty/Presenter Disclosure
Speaker’s Name: Speaker’s Name
Relationships with commercial interests:
Grants/Research Support: PharmaCorp ABC
Speakers Bureau/Honoraria: XYZ Biopharmaceuticals Ltd
Consulting Fees: MedX Group Inc.
Other: Employee of XYZ Hospital Group
Please fill out all applicable areas (highlighted in red). One slide per speaker.

3. Disclosure of Commercial Support
This program has received financial support from [organization name] in the form
of [describe support here – e.g. educational grant].
This program has received in-kind support from [organization name] in the form
of [describe the support here – e.g. logistical support].
Potential for conflict(s) of interest:
[Speaker/Faculty name] has received [payment/funding, etc.] from
[organization supporting this program AND/OR organization whose product(s) are
being discussed in this program].
[Supporting organization name] [developed/licenses/distributes/benefits from
the sale of, etc.] a product that will be discussed in this program: [enter generic
and brand name here].
Please fill out all applicable areas (highlighted in red).

4. Mitigating Potential Bias
[Explain how potential sources of bias identified in slides 1 and 2 have been
mitigated].
Refer to the College of Family Physicians of Canada’s “Quick Tips” document.
Please fill out all applicable areas (highlighted in red).
Please visit the following link for the CFPC’s “Quick Tips” document:

5. “ online booking…” “Improved office workflow..”
Needs Assessment- What We Heard From You
What challenges?
“ I have limited work days for patients…”
Patients have difficulty getting through
on the phone
Hope to learn?
“ online booking…” “Improved office workflow..”
What could be improved?
“Managing waitlist…”
“… getting patients into rooms”

6. Agenda Welcome Practice Support Program (PSP)
Overview of Advanced Access
Key Concepts and Indicators:
Panel Size, Supply & Demand, 3rd next appt, Backlog
Review and Discussion
Action Period Planning

7. At the end of today’s session participants will:
Be able to understand Advanced Access and how it can benefit their practice
Understand a proven evidence-based process for implementing small, but significant innovations to improve access
Have a plan for implementing these changes into their practices over the next few months

8. What is the Practice Support Program (PSP)
An initiative of the General Practice Service Committee
PSP offers funded and accredited modules
Modules are peer led by Peer Mentors with support from PSP Regional Leads
Modules are for GP and SP practice teams
Goal: Change management and quality improvement for physician practices
Coaching support for other quality improvement ideas
Bi-partite committee between the government and the Doctors of BC to address full-service family practice incentives
PSP:
One of the three major initiatives of GPSC including Incentives; Divisions of Family Practice and the PSP
Funded through the 2006 agreement between the government and Doctors of BC
Governed by GPSC
We are not CME. PSP is about making permanent clinical and administrative changes in your practice. Small changes are tested and results are shared to help each other improve. Collaborative work is based on the concept of trying out small changes “next week” and then refining, testing again, and once you are ready, embedding the change into the practice as a new way of doing things. Small changes are tested on an ongoing basis to reap the benefits of small gains. Results are tested and tracked on an ongoing basis to see what works and what doesn’t.
Physicians and MOAs are reimbursed for their time away from their practice; dedicated time to reflect on their practice

9. What We Do
Learning modules are physician-led group training sessions offered in communities throughout BC. These group sessions are followed by action periods during which PSP participants try out what they have learned in their own practice.
Practice coaching is ongoing support provided by PSP regional coordinators to help physicians (including those who have not participated in a PSP learning module) implement practice changes and sustain improvements.
Practice Self-Assessment provides GPs with a simple method for examining the needs of their clinical practice and identifying key areas for change or improvement. You and your staff can explore new ways of working to enhance the efficiency of your practice and your effectiveness as care providers.
Place to say “and we are experimenting with you” need your feedback.

10. How is QI different than CME?
Action-oriented: try what you learn – “What are you going to do next week?”
Test and implement in small populations, then spread to the larger population
Feedback and discussion with colleagues

12. Why Are We Here? Setting up the learning objectives Overriding Goals
To improve patient access to primary care physician offices.
To improve the quality of patient care by improving physician and staff communication skills.
To improve the patient and physician experience by improving office workflows
Learning Outcomes
By the end of the implementation, participants will be able to…
Implement Advanced Access techniques for office scheduling of patient appointments
Improve office workflow by implementing appropriate office efficiencies
Employ communication strategies to improve patient-physician and patient-MOA interactions
Implement a proven evidence-based process for making small, but significant changes into primary care office practices
Have a plan for implementing these changes into their practices over the next few months
Key Messages in this program include…
Using a patient-centric approach to the provision of health care services improves provider and patient experience
The implementation of office efficiencies can improve office workflows
Patient wait time can be shortened by employing Advanced Access techniques.

13. Dr. Jones
Case Study:
Dr. Jones is a GP practicing in a group clinic in North Vancouver.
Although he loves his profession, there are many aspects of it that he would like to change.
What his day looks like:
Dr. Jones is…
Unable to see his patients in a timely manner
Always running late
Receiving patient complaints of wait times and having to bring a ‘shopping list’
Unable to provide continuous care because some patients go to walk-in clinics
Dissatisfied with status quo
Worried about his MOAs doing patient triaging
Experiencing No Shows
Close to burn out, as is his staff
Facing a fully booked office every day
Having to accommodate Fit Ins

14. What is Advanced Access?
Practice Management Module
Seeing your own patients when they need and want to be seen
Eliminating delays for an appointment
Evidence based – Studies performed in Canada, US and Scandinavia
“See your own patients, and don’t make them wait.” Dr. Mark Murray
Advanced access has been implemented successfully in all settings, contexts and systems
Dr. Mark Murray
Description of literature and evidence
please refer to the articles provided (in AA resources)
Canada, US and Scandinavia
Fee for service

15. Advanced Access Physician: “I can do all of today’s work today.”
Patients: “I get the care I need when I need it.”
Two important concepts relate to timeliness of work and care.

16. What Advanced Access is not:
Not for increasing your panel size
Carving out time in your already full schedule
Asking the patient to call back the next day to schedule an appointment on the “same day”
A government plot to make physicians work harder!
Animation
Four key points about what Advanced Access is not. It’s not an expectation that you will take on more patients, nor will it create space in your schedule for you to do other things than patient care.
Many people are very strict in their scheduling and use advanced access to “Phone back tomorrow and make a same day appointment.”; this is a method to understand your supply and demand and make the best use of the time you have available to see patients.

17. When doesn’t advanced access work?
Some practices have had great success in improving access with this model, while others have failed.
A study of six primary care practices found that five of the six improved access but none achieved same-day access, and the improvements were often not sustainable over time.
A systematic review of the literature on advanced access concluded that most practices can reduce waiting times but few accomplish same-day or next-day access.
Moreover, patient satisfaction did not increase and in some cases decreased even when access improved.
What is the key to successfully improving access?
Practices that have implemented same-day access, and have sustained it over a number of years, have reduced demand and increased capacity by working on the building blocks required to provide prompt access to patients.
These building blocks include:
panel size management,
continuity of care,
and the development of teams that add new capacity to deliver care without pushing work back to the physician.

18. What challenges have to be overcome for advanced access to work?
Panel size management
Continuity of care
Development of teams that add new capacity to deliver care without pushing work back to the physician.
Panel size management. To keep demand for care in check, practices with sustainable open access models start with creating manageable panel sizes, ideally empaneling patients to a team. If panels are too large, then the demand for care will overwhelm the capacity to provide care – even with staff members assisting physicians in providing care – and prompt access will be impossible to achieve. To create more capacity to manage panel size, practices may need to adopt strategies such as encounters, group visits, nurse visits, and health coach visits. Practices can also better manage their panels by replacing multiple low-level visits with one robust visit, and by increasing the time between follow-up visits when medically appropriate.
Continuity of care. As often as possible, patients should be seen by the physician or other team member to whom they are empaneled. Continuity of care not only improves patient outcomes but also helps to reduce demand for care since patients seeing a different physician often receive another appointment with their own physician, thereby filling two appointment slots rather than one. In some practices, physicians have agreed to overbook their own patients as needed, but not patients empaneled to other physicians, to improve continuity.
Development of teams that add new capacity to deliver care without pushing work back to the physician. Examples of the capacity that teams can add:
MOAs asking for the reason for the visit and recording this in the schedule. This allows proactive preparation for the visit. For example, the office staff can pre-weigh diabetic patients and test FBS or have current Hgb A1c results ready, people with HTN can have their BPs checked on automated BP devices immediately before seeing the doctor, appropriate questionnaires can be handed out in the waiting room (PHQ9, Pain Disability Index, Sleep Questionnaires)
Social Workers can deal with issues related to the social risks of health (poverty resources)
Pharmacists can do medication reviews

19. Before Advanced Access
Dr. Jones’ schedule had:
CPX, Regular Appointments, Shots, Well Baby, Over 80, Minor Procedures, Paps, Prenatal, Post- Partum Checks, Fit in’s
Appointments with different time values
Many Rules
Which led to:
Mistakes
Longer Training
How Dr. Jones is currently booking, what the practice is like

20. Today Two appointment types: Short and Long
Fewer Rules: Do today’s work today
Easier to teach
Fewer Rules = Fewer Mistakes

21. “Do Today’s Work Today”

22. Potential Benefits Physician and Office Benefits
• More time to manage complex chronic illness.
• Reduced stress for physicians, MOAs, and patients.
• Better use of time and resources (e.g., MOA doesn’t waste time “negotiating” with patients; fewer no shows).
• Increased quality of both work and personal life.
Patient benefits:
• Getting care when they need it.
• Treatment by their physician of choice.
• Improved relationships with doctor and staff.
• Fewer and shorter hospital stays.
• Better continuity of care.
• Increased quality of life.
• No wait/wasted time.

23. Discussion
One challenge that you face in your practice that you are hoping to address through this module
Table discussion – 10 minutes
One minute to consider and write down what is the issue for you in your office – without talking
Two minutes to share with another person in a diad – one minute each
Seven minutes to share diads’ summaries with the table

24. What Do We Hope To Accomplish
All systems work best when they work without a delay
Delays exist in family practices when patients are waiting for an appointment and while waiting at an appointment
Reducing these delays has benefits of:
Improved clinical outcomes for patients
Improved satisfaction of patients, physicians and staff
Reduced costs
Increased revenue
Improved patient-provider relationship
All systems work best when they work without a delay. Regardless of whether you are making widgets or seeing patients
Reducing these delays has benefits of:
 Clinical outcomes for patients
 Satisfaction of patients, physicians and staff
 Costs
 Revenue
 Patient/provider relationship
Reduces the # of patients with “grocery lists”
Reduces the # who go to walk-in clinics
Reduces the time the MOAs spend negotiating with patients
Reduces unnecessary return visits
Allows the patient-physician time to be optimized

25. Scheduling Models
Advantages and disadvantages of each of the following scheduling models:
Traditional
Carve-Out or Fit-In
Open Access or Walk-In
Squeeze-In
Wave booking
Virtual appointments (for Session 3)
Patient portal booking
Ask question of audience to share their experiences with each of the above scheduling models.
Traditional – appointments for predetermined time slots
Carve-Out or Fit-In – traditional plus scheduled “same day” appointments
Open Access or Walk-in – patients show up whenever and are seen in turn
Squeeze-in – traditional plus patients inserted between scheduled appointments
Wave Booking – a pre-determined number of patients are booked every half or full hour
Virtual appointments – appointments scheduled to occur using telephone or video
Patient Portal Booking – patients use an on-line portal to schedule appointments on office booking system

26. Path to Advanced Access
Knowing your panel size
Balancing supply and demand
Understanding and Working down the backlog
Reducing appointment type slots
Developing contingency plans
What takes up your supply
Reducing demand
Animate
We will cover each of these in more detail over the remainder of the session

27. Advanced Access Key measurements and concepts
Cycle Time
Third Next Available Appointment
Patient experience – Access
Patient experience – Office Efficiency
GP and Staff experience
Concepts
Supply and Demand
Third Next Available Appointment
Backlog
GP/ Pt cycle time
Cycle time – time from patient entering the office to being seen by physician

28. So…Where Do We Start? What’s your Panel Size? Supply-Demand Measures:
3rd Next
Backlog
To understand how we ended up over booked and constantly behind – we need to look at the Supply/Demand
To start to make changes we will need to be able to measure some things so we know if we are having any impact on the problem.

29. Ways to Calculate Panel size
EMR Reports
Electronic Billing
Manual Calculation

30. Supply Supply is what you have in your schedule to meet your demand.
The number of appointment slots available in a given day and the number of days you work in a week.
Not always well matched to Demand, day to day
Often more variable than Demand

31. How to measure Supply- do this now if you know your typical week
build time here 5 min
How to measure supply:
Look at the schedule and count the slots
Calculate this daily
H/o – Calculate supply
Activity – calculate supply using sample schedule 32

32. Panel size/Demand
The reservoir analogy

33. Panel Size/Demand If S < D - backlog creeps in
Panel – creates REAL work
Waiting –creates RE-WORK
If S < D - backlog creeps in
Dr. Jones learned that there are seven steps involved in implementing Advanced Access:
1. Calculate your supply, demand, and delay.
2. Calculate your backlog (good and bad).
3. Work-down the bad backlog.
4. Reduce scheduling complexity.
5. Develop contingency plans.
6. Measure cycle time.
7. Reduce cycle time.
Note: Use the shortest appointment slot as your basic unit of measurement, and record one tick for every unit requested by a patient. Record multiple ticks for patients who take up multiple appointment slots. For example, if your shortest appointment slot is 10 minutes (your basic unit of measurement), a periodic health exam may require four 10-minute appointments, or 40 minutes, which equals four tick marks.

34. What causes Dr. Jones’ demand?
Decreased Supply
Stat holidays
Vacation
Education training & conference time
Labour and delivery
Increase in Demand
Flu season
Panel too large
Day to Day supply/demand mismatch
Of these issues, the most common problem is day to day mis-match

35. Demand: Work that arises from your patient panel
Requests for appointments
2 Types:
External demand: patient driven
Internal demand: practice driven
External – patient driven
Patient requests (phone or walk-in)
Referred from ER or walk-in
Other phone calls
Internal – practice driven
Patient is requested to come in for follow-up visit
Non-appointment
Rx refills
Test results
Paperwork
Predictable and measureable

36. Why Assess the Demand from your Panel?
To adjust your appointment schedule to best meet your pattern of demand.
To understand the proportion of Internal/External demand and begin to shape it as able.
For office efficiencies LS 2

37. Table discussion What days are busiest? What do holidays do to demand?
What happens at Christmas time?
Slowest days?

38. Dr. Jones’ Demand Mondays & Fridays are the busiest days
Tuesdays & Thursdays are the next busiest
Wednesdays are the quietest day
After long weekend demand all week is similar to Mondays & Fridays
High demand: Flu season, allergy season
Low demand: Summer, back to school
* animate

39. How to Measure Demand Record every request for an appointment
Include appointment requests from all sources
Count demand on the day the request comes in regardless of when the appointment date is scheduled
Track demand daily
Demand is generated by the patients who want an appointment. The majority of requests come from your panel of patients.
In many practices, people feel their demand is greater than their supply. This needs to be measured to see if it is actually the case.
Record every request for an appointment whether an appointment is booked (e.g. patient calls but no appointment that fits their schedule is available, so they go to a walk-in clinic – this still counts as a “demand” for the doctor’s time)
Count appointment request from all sources (phone calls, walk-ins, patient booking as they leave, and fax
Count the demand on the day the request comes, even if the actual appointment is booked for another day (patient calls 13th for appointment on the 20th – demand counted on the 13th)
Daily totals show how demand may vary according to the day of the week
Weekly totals show how demand may vary according to month or season 40

40. Tool to measure Demand
Create new sheet for external demand. How many calls come into their office. AP external demand, info gathered to feed into LS 2 content for OE MOA task 41

41. Balancing Supply & Demand
MATCH SUPPLY TO DEMAND
ADJUST AS DEMAND FLUCTUATES
Increase # clinic hours Monday / Friday
Add clinic hours after long W/E
Decrease the number of appointment types and rules ( increases flexibility and patient focus)
Move to table conversation slide what would you do to shape the demand

42. Balancing Supply and Demand
Increase supply
Shape Demand
Pay attention to continuity
Consider group visits / flu shot clinics
Avoid PAPs & Follow-up on Mondays (& Fridays)
Consider longer F/U intervals
cc results to patients

43. How is Demand/Supply imbalance Measured?
3rd Next Available Appointment
Backlog

44. 3rd Next Available: Business Days1 2 3 4
Third Next Available Appointment (3rd next) Standardized measure of how long a patient will wait for an appointment
Measures the delay for appointments
1st and 2nd available appts could have been cancellations
3rd next available appt. - standard measure of access
Count the number of open slots from the time of the request to the 3rd next available appointment.
Check how many days this is from the time of request
Don’t count frozen (“urgent”, “fit in”, “carve out”, 5 minute) slots in the schedule. (wouldn’t be available anyway
Allows for Goal setting (e.g. 0 days), tracking access and monitoring progress
Third next available does not include “fit ins”, “carve outs” or 5 minute appointment slots held in the schedule
From a patient’s perspective, it is the number of days the patient waits for an appointment.
This includes weekends!
When measuring, you need to differentiate between appointment types, long and short for instance.
(Note: Stress - You are looking at your delay. The third next available is simply a number that denotes your delay) 5 6 7 8
[ Business days ]

45. What is the 3rd Next here?
Embed VCH AA inservice What else do you see that you like, colors, lunch, staff meeting, reason for appt
Today is Friday
TNAA is Wednesday at 11:30.
Therefore, TNAA is 3 days. 46

46. Progress Chart 3rd next available appointment (short)
3rd next available appointment (long)

48. Backlog: Work that has been pushed into the future
The amount of work ‘waiting’ to be done
Limits your ability to catch up
Limits your ability to meet the acute needs of patients
A constant stressor!
The total work that is waiting for you between today and the third next available appointment

49. Types of Backlog Planned backlog: Distracting backlog:
Appropriate follow up
Planned future visits
Requires the passage of time
Distracting backlog:
Today’s work pushed to the future because of a full schedule. For example, appointments requested for today that could not be accommodated today
Scheduled appointments that may be unnecessary
What do we do now?
After calculating the supply, demand and third next available appointment
Next Step- calculating the work that is waiting for you (number of appointments)= Backlog
Backlog (the reservoir):
Is work that is requested and booked but is currently unmet clinical need
Backlog creates the delay for appointments in your practice. The more that work is pushed into the future, the longer the delay will be, and the more rework that will be done in the meantime.
Reducing your backlog results in a reduction of delay

50. Calculating Backlog Backlog: Defined as work booked into the future
Planned backlog = appropriate follow-up / planned future appointments
Distracting backlog = today’s work pushed into the future
To calculate distracting backlog:
Count total booked appointments until your 3rd next
Subtract ‘planned’ backlog (the appropriate future appointments)
Balance = true backlog
Total Distracting backlog in this example = 84 appointments
To calculate the hours of work to be done to eliminate backlog, divide the total ‘distracting’ backlog by the number of appointments seen per hour.
In the above example, if the physician books 4 appointments per hour, it will take 21 hours to clear the backlog (84÷4)

51. Examples of Planned Backlog:
Now You Try It …
Examples of Planned Backlog:
CPX (complete physical exam)
Drivers CPX
Pap/pelvic exam
baby shots
minor procedures
counseling
Total booked appts until 3rd Next
– Planned BACKLOG =
TRUE BACKLOG
÷ # appts/hr = #of hrs extra
of needed to clear backlog
Take out your sample schedule #1, how does it look? 30 total appts/day
Calculate your TNAA (3rd next available appointment)
Now your backlog
117 backlog appts
53 planned backlog appts
=64 distracting backlog
‘/. 4 (appts/hr)
=16 hrs needed to clear backlog

52. Group discussions: How would you deal with your backlog ?
Stop adding to backlog (make every effort to do today’s work today)
Add 1 hour/week or temporarily increase hours on busiest days
Add another day if possible
Review schedule & deal with any appointments via phone or , if possible
Bring in a locum to offload work
Call pts to see if they can come earlier; move some appointments from the future to any open slots in today or tomorrow’s schedule
Make better utilization of practice team MOA, RN, LPN and other team members’ skills to
Take BP, weight, etc.
Discuss medications with patient
Review lab results
Take patient histories
Consider group visits
Prescription renewal process
Proactive plan for Chronic disease patients with multiple follow-ups
Test results

53. Questions

54. Break 55

55. Planning for Time Out of Office: Anticipated or Unanticipated
Contingency planning is proactively anticipating disruptions in your scheduled workdays: attending meetings, delayed at hospital, holidays, sick times, etc.
We know this will happen, and can take a proactive approach to address variation in supply
One example of a contingency plan is the Freeze/Unfreeze strategy 56

56. Dr. Jones’ vacation ... “Freeze/Unfreeze”
Before holiday begins: – freeze all appointment slots for physician’s 1st week back
Freeze / Unfreeze (A “Vacation Re-entry Survival Plan” )
The strategy is pro-active planning:
Freeze these slots as soon as you know you are going on holidays
Before holidays, all appointment slots for the physician’s first week back are frozen– no bookings accepted for this time period (pre-planned, before the physician’s holidays began)
During the last week of the physician’s time out of office, the MOA will selectively unfreeze parts of the first week back
This help buffer the potential build-up of backlog (and subsequent delay) that would normally occur when there is time out of office
Demonstrate, using next slides …
(1st week back) 57

57. “Freeze/Unfreeze”
On Monday of the last week of holiday, open the schedule for the Monday morning of the 1st week back
On the Monday of the last week of holidays, the MOA will open up the Monday morning of the following week (i.e., the physician’s first week back)
On the Tuesday of the last week of holidays, the MOA will open up the Tuesday morning of the following week (i.e., physician’s first week back)
The MOA will continue to unfreeze mornings on a day-by-day basis
By the Friday prior to the physician’s return, the first week back will have all of the mornings open
(1st week back)
MOA will continue to unfreeze mornings on a day-by-day basis … 58

58. “Freeze/Unfreeze”
On the Monday of the 1st week back, open the afternoon appointments for that same Monday
On the Monday of the physician’s first week back, the MOA will open the afternoon appointments for that same Monday
On the Tuesday, the MOA will open the afternoon appointments for Tuesday
Each day, the MOA will continue to open up afternoon appointments for the same day of work
(1st week back)
MOA will continue to unfreeze afternoons on a day-by-day basis … 59

59. Yogi Berra Tools For Change
“ If we keep doing what we’re doing, we’re going to keep getting what we got.”
Yogi Berra

60. Example of patient check list when people arrive for their appointment

61. Review of Today Supply & Demand Panel Size Benefits of Same Day access
3rd Available Appt- Baseline
Backlog Tips
“Freeze Unfreeze”
Your Plan?
PSP Facilitator
-Today you’ve hear the presenters speak about ways to start thinking, assessing, and acting on how to improve your office efficiencies and processes.
-You’ve learned many concepts such as:
1. Benefits of doing today’s work today
2. Ways to measure both your demand and supply to assess how your practice is doing - This includes looking things such as your panel size, 3rd next available appointment and calculation of backlog and strategies for decreasing backlog.
3. The freeze/unfreeze approach to help deal with physician time away from the office
Patient surveys – a good way to learn the perspective of those who experience your services
PDSA – Plan, Do, Study, Act – a concept that encourages you to narrow down processes you want to change by testing it step by step – small increments of change to test if a new approach works or not
So what is next – what is your plan now that you’ve started to learn these concepts….NEXT SLIDE

62. Use region specific action planning form here…Remove target dates for completion, keep who is responsible. Have them identify what they will do, set milestones. Reminder date not set in stone.
- We are all here to support your learning and process changes that you will make throughout this Advanced Access module. We are here to help you complete your action planning work – to assist you individually with what makes your practice unique, and how to help you identify and act upon small changes step by step.
From this slide may I draw your attention to this action period #1 sheet in your handouts. This sheet outlines the tasks and goals for your practice and the target dates for their completion as part of your action planning one session. It is a white/yellow carbon copy that you will have time to fill out tonight. There is a spot on this form to choose your first appointment time with a PSP coordinator.
Please note -In confirming your registration of tonight’s session, we have already heard back from some of you on booking our first dates to go over baseline data from you office – so thank you to those who have already given us your availability. We will be contacting you this week to confirm dates and times to meet over the next few weeks. If you did not indicate an appointment time, please do so on this form.

63. Adjust this form as necessary to your region
Please find another form – yellow in colour- in your package called the pre baseline data form in your handout package due on Feb 24/12.
-This form will help you collect initial data on: 3rd next available appointments, panel size, backlog, supply and demand, appointment types, and patient surveys.
Again, Swati, Jo and I will be making appointments with each of the practices to help you determine how to compile and collect the data. We are all available by phone or to answer any of your questions each step of the way.

64. Where do I start? What are you going to do next week?
What is your aim?
Determine how you will measure/track improvement
So, what are you going to do next week – to start small steps of change in your practice?
What is your overall aim?
How are you going to track and measure as you embark on making changes?

65. Good Luck!
I hope you found the discussion time useful as a spring board for the AA action period #1.
You don’t need LUCK, as this slide depicts, because your PSP team will be with you every step of the way to help you be successful in this endeavour.
-Please also fill in the blue evaluation forms – we care how you found this session and we truly look at your ratings and comments so that we can continue to improve. Please hand in evaluation forms at the front registration desk, where you can pick up your billing forms and your complimentary parking passes.
**Lastly, I wanted to point out the samples we have on the walls, called “Dr. Storyboard” – These are from another AA module, where each practice shared their changes in poster format with the rest of their colleagues in the 2nd Learning Session. Please have a peek at these, as we will be doing the same for our learning session #2 in April. You will see blank ones with samples of the forms from your packets that you will be using – and then a sample by a real practice team. Don’t worry, the PSP leaders will be the ones creating the story boards for each practice for the next learning module. We will organize it all. 66

66. Next Learning Session Date
Please make a note of the date of the next learning session – evening session, same format to be expected.
Thanks to the physician facilitators for their leadership in this module.
Again, we at PSP are here to support you and coach you each step of the way.