1. www.HQOntario.ca Advanced Access, Efficiency and Chronic Disease Management in Primary Healthcare Date: Name of Presenter: WAVE 6

2. 1 Agenda Introduction About Health Quality Ontario Introduction to Advanced Access Overview of the Learning Community Overview of Wave 6 Questions & Discussion www.HQOntario.ca WAVE 6

3. 2 Health Quality Ontario (HQO) HQO is an independent agency created by the Government of Ontario to: (a) monitor and report; (b) support continuous quality improvement; (c) promote health care - supported by the best available scientific evidence.

4. 3 Accessible Care “People are able to get the right care at the right time in the right setting by the right health-care provider”

5. 4 Waiting…for a Family Physician in Ontario 2011 report on Ontario’s Health System; HQO % of adults able to see their GP same or next day

6. 5 Delays are common in our system: Delay Getting to GP Delay Getting Tests Delay Seeing Specialist Dissatisfaction, adverse clinical outcomes, increased costs

7. 6 Patients have trouble booking appointments? Receptionists say “no” a lot? Feel overwhelmed with demand? Find it difficult to bring patients back for follow-up? Experience a lot of “no shows”? How Are You Doing?

8. 7 What is Advanced Access? Timely patient access to a scheduled appointment Measured in days: Third Next Available Appointment (TNA) Excellent access is when a practice can accommodate a patient’s day & time of choice with his or her primary care provider

9. 8 “Advanced Access” is about Reducing delay Patients see their provider on their day of choice Doing today’s work today Matching provider supply to patient demand Improving the patient/provider/team experience A philosophy….not a product

10. 9 Access is not about Limiting patient’s ability to book in advance Prioritizing access over continuity Making you work harder/ faster/ longer Promoting a walk-in culture Unleashing limitless demand

11. Moving Towards Advanced Access 10

12. Access to care can be improved…. By understanding and balancing your Demand and Supply Demand (From your panel) Supply (By your care team) 11

13. 12 First, consider your annual Demand & Supply How many appointments are requested by your patients in a year? Panel size x revisit rate Demand How many appointments do you offer in a year? Appointments/week x weeks worked/year Supply

14. 13 Next, measure your Demand and Supply on a daily basis

15. 14 Demand How many people ask for an appointment each day? External Demand Internal Demand Mon Tues Wed Thurs Fri I I I I II I I How many return visits are booked? I I I I I I I I I I I I I I I I I I I I From your panel

16. 15 Supply By your care team How many appointments are offered each day? Total Demand Supply Mon # Tues # Wed # Thurs # Fri # # # # # #

17. If not, test changes until a balance is achieved. Balancing Supply and Demand involves examining the way you deliver care and takes time. Does Demand balance with Supply? For ideas on how to test changes to achieve a balance, visit the Learning Community Gateway www.hqolc.ca 16

18. Once the care team has balanced Supply & Demand… Reduce your backlog How large is your backlog? 17

19. 18 To Measure Backlog: 1.Count number of booked appointments between now and the third next available appointment (TNA) 2. Subtract “Good Backlog” 3. Add temporary supply to catch up until provider/care team is doing today’s work today

20. 19 Going forward, offer Supply that matches Demand =

21. 20 Maintaining Access requires matching supply to demand – daily & weekly External Demand Internal Demand Mon ## Tues ## Wed ## Thurs ## Fri ## ##### # ### # MonTuesWedThursFri

22. 21 1.Booking Appointments: Offer an appointment today, or if patient requests, another day. Book return visits early in the day and late in the week. 2.Maintain Good Access to Care Contingency plan for variation Continue testing improvement ideas and measuring Important Strategies

23. 22 6 Principles of Access 1.Understand and Balance Supply and Demand 2.Increase Supply of Visits 3.Reduce Demand for Visits 4.Reduce Appointment Types and Times 5.Reduce Backlog 6.Develop Contingency Plans

24. 23 Case Studies with Advanced Access

25. 24 6 Principles of Efficiency 1.Balance supply and demand of non-appointment work 2.Synchronize patients, providers, information, rooms and equipment 3.Anticipate and predict patient needs 4.Optimize rooms, staff and equipment 5.Manage constraints 6.Eliminate waste

26. 25 What’s in it for me and my patients? Improved patient satisfaction Improved physician and staff satisfaction Improved ability to organize care processes and continuity of care Less cost to healthcare system

27. 26 Challenges Measurement Engaging staff Change Sustainability and Spread

28. 27 Learning Community: 3 Main Elements Model for Improvement, CDPM Framework Clinical Practice, Evidence-based Guidelines Active Learning Cycles A virtual on line real-time workspace Infrastructure Gateway QI coach Support

29. 28 Benefits of a Learning Community: Learn Share Innovate Improve LearnShare InnovateImprove Learning Community

30. 29 Access plus Chronic Disease Management Growing population in Ontario Demanding on primary care and all levels of health care Improvements in primary care can impact: Patient outcomes Entire system of care Better patient transition between levels of health care improves patient experience. WAVE 6

31. 30 Wave 6 Highlights Starts March 20 th, 2013 9 month + 3 months data collection Apply until March 1 st, 2013 Readiness assessment required Coach support by stream Team obligations WAVE 6

32. 31 Questions ? Website: www.hqolc.ca Contact us: learningcommunityinfo@hqontario.ca www.HQOntario.ca WAVE 6

33. www.HQOntario.ca