1. Advanced Access/Office Efficiency
PSP master PowerPoint template specifications
Font throughout: Myriad Pro
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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 2
Presenters name here
Location here
Date here

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. Some info
A few housekeeping items: cells, washrooms. We know emergencies sometimes come up, please feel free to leave the room if you need to take a call
The agenda is on the table in front of you. Of importance you will note we are having a break for coffee around: (time)
Housekeeping
washrooms and nearest fire exist
Ground rules
Respect all ideas and opinions
Share experiences with your peers
On time back from break
Cell phones on mute or vibrate?

6. 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.

7. Practice Support Program (PSP)
Sustainability Support
LS AP1 LS2 AP LS3
Learning sessions
Peer-led learning, team based approach
Periods between Learning Sessions work with PSP Support Leaders to implement changes into practice
Action Period
Created through a tripartite agreement with the Ministry of Health, the BCMA, and the Health Authorities
Based on feedback from the GPs: Trained, Supported. Paid
Supports GPs and their practices to integrate new ways of doing things into their practices
Goals:
-Improve access for patients to guideline-based care
-Improve physician satisfaction
-Make family practice a more attractive option to graduating physicians
Current modules =
Chronic Disease Management
Group Visits/Patient Self-Management/Health Literacy
Advanced Access
Mental Health
End of Life
Upcoming modules =
CYMH
MSK
OPUS
Hollander surveys baseline and post.
Session evaluation and sustainability surveys
Evaluations

8. Agenda Welcome Stories from Action Period 1.
Office efficiency - why is it important?
Current office challenges.
Small group breakouts - Solution Centres.
Next steps…

9. Your stories from Action Period 1
Open phone lines early
Schedule grooming
Tracking reason for visit
Four questions

10. Office Efficiency Why is this important? Scenarios:
The laundry list of complaints
Going in blind to the appointment
Phone ringing off the hook while patients line-up
My clinic day ended two hours ago

11. Benefits of Improved Office Efficiency
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
Income is increased. 11

12. Collaborative Measures
Delay for appointment
Cycle times
Patient experience – Access
Patient experience – Office efficiency
Provider and staff experience
Review of Measures for concepts learned in LS1
These are the measures for success in this work. The context and what specifically will be measured will be introduced shortly.
You will use this information to determine whether the changes you will make have made the difference that you intended.
It is very important to keep in mind that measurement is for improvement, and not for judgment. You are all starting with different delays, different processes, and will have different practice level aims. You measure to see the starting point, and how you are progressing.

13. Measure of office efficiency
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.
Review of LS1 concepts
Cycle Time is the measure of the time taken for the appointment, including all unnecessary delays. It is the time from “check-in” to “check-out”. Therefore this is used to gauge improvements in office efficiency
What is actually being measured is total time with physician, staff, non-physician time, and waiting.
NB: There is no “ideal” cycle time. Rather it is dependent on the patients and the practice style. However, the goal should be to maximize the value which means getting rid of “waits” and delays in the appointments.
Why measure patient cycle times?
Gain insight into possible areas of improvement in practice processes
Help assess your practice – from patient’s perspective
From a practice and patient perspective, there is value added time, and non-value added time
Again, the goal is to optimize the value added time, i.e. time with the provider, and decrease non-value added time
Method of tracking
One option is to use a cycle time tracker, and sample throughout a day for each provider. First and last appointment of the am and pm, plus one more in the middle of the morning for instance (5 total), and on one day of the week to start.
Have the patient keep track, with the initial times filled in by the MOA, or have someone shadow the patient and keep track.
Covers from time of “check- in” until time of “check-out” (don’t worry about patients who arrive early, as the actual scheduled appointment time is noted on the sheet)
Those of you with an EMR may be able to use it to capture some of the information
(Advise participants that their package includes an information sheet about cycle time, as well as a blank template of the survey.) 13

14. Patient Survey
Example of Patient survey

15. Sharing Current Office Challenges
Large group facilitated Discussion
Share what your office has tried out.
How did it go?
What did you learn?
What challenges were there?
What surprised you?

16. Small Group Breakout: Solution Centres
Find a topic that resonates with you.
Limit of seven people per table.
Three rotations of 25 minute discussions.
Facilitator at each table will remain there throughout each rotation.
Participants move to next topic when time to rotate.
Cannot find your challenge - start a topic.
One 25 minute rotation before break

17. Breakout discussion questions: Rotation 1
One 25 minute rotation before break

18. Break… 18

19. Small Group Breakout: Solution Centres
Find a topic that resonates with you.
Limit of 7 people per table.
3 rotations of 25 minute discussions.
Facilitator at each table will remain there throughout each rotation.
Participants move to next topic when time to rotate.
Can’t find your challenge- start a topic.
Two 25 minute rotations after break

20. Breakout discussion questions: Rotation 2
One 25 minute rotation before break

21. Breakout discussion questions: Rotation 3
One 25 minute rotation before break

22. Where do I start? What are you going to do next week?
What is your goal?
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?

23. Action period planning tool

24. A few more things… Please complete and submit:
Session evaluation form.
Action period form with follow up visit date.

25. 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.

26. Practice Support Program
For more information
Practice Support Program
West Broadway
Vancouver, BC V6J 5A4
Tel: