High Leverage Changes for Specialty Care and Program Teams - Access
The following table includes strategies that could be used to help you achieve your access aims. Please remember that not all
strategies will apply to every clinic, so consider the ones that you feel would be most beneficial in your situation.
Understand and Balance Supply and Demand
Idea/Strategy
Person Responsible
 Identify all duties and services (demand streams) provided by
SC practice. Identify patient care duties and non-patient care
duties. Identify the amount of FTE (supply) currently allocated to
manage each of these demand streams, both by the entire
practice and then by individuals. Identify the amount of FTE
(supply) allocated to each of these demand streams by the day,
week, and month. Separate and focus on the office demand
stream.
 For the “office” demand stream, measure daily and weekly
demand for all appointment services, by the practice/clinic and by
the individual.
 Segment total demand for appointments into new and return by
day of the week, and by the week.
 Measure the ratio of new to return on the schedule, and measure
the ratio of new to return by the visit return rate
 Measure and analyze from where and from whom the work
comes—point of referral—to inform the service agreements
 Analyze what the work is—symptoms, diagnosis, condition—to
inform service agreements
 Measure supply of appointments for all clinical providers and
staff (clinical FTE). This is a more granular measurement of the
first box.
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Understand and Balance Supply and Demand
Idea/Strategy
 Measure the daily and weekly practice and individual
appointment activity ( number of visits seen)
 By measuring demand, identify number of appointments required
daily and weekly to meet daily and weekly demand for new
appointments. Focus on the new demand.
 Determine current caseload by practice and by provider
 By using the caseload equation in the Excel spreadsheet,
determine the “ideal” caseload for the practice. Compare current
to equitable share (if work was divided by FTE contribution) to
the ideal
 Measure return visit rates by practice and individuals
 Commit to doing this week’s work this week
 Identify plan to continuously measure demand/supply for
appointments
 Develop an “input equity” (pooling) for new patients
 Develop a plan to monitor caseloads monthly
 Develop a plan to adjust caseloads as needed
 Measure TNA for new and return
 Measure TNA for individuals, practice average and for “any”
Person Responsible
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Reduce the Backlog
Idea/Strategy
 Ensure that the TNA for new appointments is stabilized, by
balancing supply and demand
 Measure the extent of the backlog by measuring TNA
appointment, or by counting the number of patients waiting for an
appointment, by individual providers and by the practice.
Separate the new from return BL and focus on new
 Distinguish between “good” and “bad” backlog. There is no good
backlog for new appointments
 Create a plan to reduce the backlog (add additional
appointments)
 Develop a communication plan
 Set begin and end dates
 Plan to use “smart strategies” -demand/supply strategies in
parallel to BL reduction
 Develop a plan for any “needs” during backlog reduction,
including a plan for staffing support.
 Display wait time data where all can see it
Person Responsible
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Reduce the Backlog
Idea/Strategy
Person Responsible
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 Protect the providers with short wait times from overload of new
patients
 Utilize demand and supply reduction and balancing strategies
 Be cautious about creating wait times deeper in the flow system.
BL reduction in office can create BL for OR. BL reduction plans
then are iterative
Reduce Appointment Types
Idea/Strategy
 Develop distinct appointment types for new and return
 Set the ratio of new to return based on the current visit return
rate. If patients come in on average 4 times a year, the first visit
is new and the other three are return—that’s your ratio.
 Identify any appointments tied to a room or specific staff, or that
need more time when considering more than 2 appointment
types
 Review critically any priority and triage systems
 Pool referrals and have a plan on distribution of new
appointment work
 Other ideas
Reduce Appointment Types
Idea/Strategy
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Develop Contingency Plans
Idea/Strategy
 Study the demand/supply appointment pattern and discover all
causes of demand or supply variation
 Develop proactive plans for demand surges and variances.
Focus on supply flexing. Common demand surges are covered
below.
 Identify any potential seasonal variation in demand. Identify and
eliminate any system designs that “hold” and batch appointment
demand—i.e., intake processes, late release of appointment
supply, etc.
 Attempt to work with a shorter waiting time than articulated by
the goal, in order to create surge capacity or a buffer if demand
rises.
 Review any work plans with midlevel providers
 Supply variation: Develop time-off policies. Keep in mind that
supply is allocated across numerous demand streams, some of
which are never substituted for, so time-off policies for the office
are extremely difficult to manage.
 Supply variation: Review bookable hours
 Develop and implement a plan for booking providers who are
away, and for post-time out of the office. Review paper on post-
Comments
Develop Contingency Plans
Idea/Strategy
vacation scheduling. Review the pattern of returning to the
office, including issues like “make up for lost call.”
 Measure new patient demand by the day and by the week
 Pool the referrals initially by FTE, which is commonly done in
sequence; then shift quickly to pooling not in sequence but in
bolus.
 Schedule to ensure enough new patient capacity each week to
keep up with predicted new patient demand. This may require
altering of fixed schedules and/or flexing new to return
appointments.
 See all new patients less than the TNA goal in order to create a
surge capacity to handle any variation
 Flex ratio of new and return appointments in order to keep up
with predicted demand
 Develop a plan for the appointment and non-appointment work of
the absent providers
 Develop a plan for working with midlevel providers, if applicable
 Develop scripts for common occurrences
 Readjust staffing hours to meet pattern of demand
 Other ideas
Person Responsible
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Reduce Demand
Idea/Strategy
 Develop Service Agreements to define the work for the practice.
This can reduce new patient demand.
 Within the Service Agreements, define the packaging of the
work. This will reduce the process time, “demand burden” and
bouncing-back of referrals.
 Develop “graduation plans “ within the SA to reduce return visits
 Review return visit intervals for the practice and individuals.
Consider extending intervals for return appointments if
appropriate
 Use other team members during a visit as an alternative to make
visit more effective
 Do as much as possible with each visit. For example, patients
referred to SC for procedure can get the procedure done on the
first visit rather than having a screening visit done first.
 Use other team members during a visit to make the visit more
effective
 Develop a plan to reduce Fail to Keep Appointments
 Create alternatives to traditional face-to-face interactions,
including group visits, e-mails, telephone and case management
Person Responsible
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Optimize Care Team to Increase Supply
Idea/Strategy
 Ensure that all roles in the practice are maximized to meet
patient needs. Do a care team workload analysis for the entire
practice.
 Flow-map the patients’ journey across the SC practice,
identifying those practices where patients see a number of
different disciplines or provider types with a handoff, either within
days or between days. Identify which of those provider types are
the constraint. Use the care team workload analysis on the
constrained provider first.
 Take all unnecessary appointment work away from providers
 Reduce variation in provider styles
 Use guidelines or protocols for the treatment of simple, common
conditions, primarily in the follow-up arena
 Look for appointments that could be managed by non-physician
providers
 Look at the efficiency in other venues of care
 Other ideas
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