New Practices and Providers in Primary Care
Advanced Access & Efficiency
(Your Name) – QIC
Health Quality Ontario
www.HQOntario.ca
Objectives
To understand:
• how the principles of Advanced Access and
Efficiency relate to new providers/practices
• how the Panel Size Equation can be used to monitor
and stay in balance
• how to use data to inform the work
www.HQOntario.ca
1
Overview of Advanced Access and Efficiency in New
Primary Care Practices
Use Panel Equation as a starting
point
Supply=Appts/wk X wks
worked/yr
Demand=Roster X revisit rate
Optimize roles of all
team members
(Who can and should be
doing what)
Develop EMR database
consistency starting
with your rostering
process
Monitor TNA on an
ongoing basis adjust ratio as
needed
New system,
coworkers
Get patient input
often and act upon
feedback
Develop contingency
plans before they
are needed
Reiew Prinicples of
Advanced Access
=
Measure ratio of
&
More time needed
at appointment
new visits:return
visits
Efficiency often
While rostering - use
every other appt. slot
using the in between
slots for return visits
Use Principles of Efficiency
to maximize office
processes
www.HQOntario.ca
(such as Process maps)
Who are we and what do we do?
Give the patient an appointment when they want or need
one
AND
See your own and don’t make them wait
AND
Do today’s work today
Mark Murray M.D.
www.HQOntario.ca
3
Principles of Access
1.
2.
3.
4.
5.
6.
Understand and Balance Supply and Demand
Increase Supply
Decrease Demand
Reduce Appointment Times and Types
Reduce Backlog
Develop Contingency Plans
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4
Principles of Efficiency
Balance supply and demand for non-appointment work
Synchronize patient, provider, information, rooms,
equipment
Predict and anticipate patients’ needs
Optimize rooms, staff and equipment
Manage constraints
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5
The Panel-Size Equation
Supply = (# Weeks worked/year) X (#
appointments/week)
MUST EQUAL
Demand = (# of pts/clients in pane)l X (visit rate)
S
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D
6
The Panel-Size Equation
(an example)
Supply: (Weeks worked/year) x (appts./week)
46
x
92 = 4232
Demand: (Panel Size)
1200
x (visit rate)
x
3.5
= 4200
This is an example of a balanced practice
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7
Visit Rate Calculation Example
In a practice where:
Weeks worked = 45
Appts./week = 105
Panel Size = 1000
45 x 105 = 4.7 visit rate
1000
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8
Electronic Medical Records
• Give extra attention and careful consideration to
data entry
• Do not assume that everyone is using the same
‘operational definitions’
• Standardize the way things go into the database to
make retrieval easier
• Is it DM? DMT2? DMII? or some other variation?
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9
Things to Consider
• Clinic hours of operation (especially if part-time)
• If possible, spread available time across week
• Don’t bunch time at beginning or end of week
• Example – for 3 days in office consider Monday,
Wednesday, Friday instead of Mon, Tues, Wed
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10
Three Moving Parts
1) Everyone is getting used to the new system and to
each other
2) New patients require more time at an intake appt.
3) New patients will generate more follow/ups initially
so visit rate will start out higher
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11
Scheduling Strategies during
Rostering
• Book every other appointment – allows
enough time for each new patient
• After awhile use in-between slots with F/U’s
as they will require less time
• Once closer to target, reduce number of slots
required daily for new patients
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12
Begin to Measure
Each week:
– Measure the ratio of New Patients/Clients: Return
Follow/ups
– This will give an indication during initial phase
how many return visits are generated by new
patients/clients
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13
Team Roles
• Maximize all team members’ scope of
practice
• Involve everyone in rostering process
• Decide prior to taking on patients/clients what each
team member will do
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14
Team Roles (cont.d)
• Be flexible and revisit roles often at team meetings
• Be open to what is working and what is not working
• Consider morning and/or afternoon huddles to
reduce interruptions and increase readiness
for appts.
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15
What About Wait Times?
• Monitor Third Next Available (TNA)
• Wait times will fluctuate during rostering
due to variables mentioned earlier
– New system, new staff
– New patients/clients take more time
– New patients/clients generate more follow ups
Wait times will stabilize closer to end of rostering
process if balance in equation is maintained
• Wait times will stabilize towards end of rostering
process if balance in equation is maintained
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16
Continue to Measure
• TNA for:

new patients

return visits
• Based on info have strategy if wait passes 5 days, 10
days, etc
• As a team ask yourselves: How could the schedule
be reworked?
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17
Principles of Efficiency
• Create process or flow maps of various office
processes
– e.g. routine patient appointment, chronic disease
visit, well baby check up, prescription renewal, etc
• Decide as a team how and when non-appt
work will be handled
– e.g. med refills, forms, lab reviews, etc
• Review processes often and refine as needed
• Test different ways of doing things before
implementing permanently
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18
Example of a Process Map
(during)
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Example of a Process Map
(After)
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Appointment Lengths
• As a team decide on a basic appointment
length
– 10 mins, 15 mins, 20 mins, 30 mins?
• Make all appointments multiples of the
basic appt.
• An example:
– Regular appointment – 15 mins;
– Chronic Disease F/U – 30 mins (i.e. 2 x 15)
– Annual Physical – 45 mins (i.e. 3 x 15)
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21
Consider Patient Input or Feedback
•
•
•
•
How will it be obtained?
Who will review
What to do with the information/data?
Methods:
– Satisfaction surveys (sampling)
– Clinic Walkthrough (Through the eyes of the patient)
– Practice Assessment (5 P’s – Purpose, Patients, Processes,
Professionals, Patterns
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22
Contingency Plans
• Discuss as a team
• Develop time-off policies for vacations, conferences,
etc prior to needing them
• Decide how to handle various events that could
affect supply of appointments required for
patient/client demand
• Reduce need to make decisions ‘on the fly’
www.HQOntario.ca
23
Will it Ever Get Better?
• By 6 to 9 months depending on rate of intake
• Variation and number of new patients will
decrease
• Understanding of panel size, demographics
and acuity will increase
• Return rate will stabilize and can be better
understood
www.HQOntario.ca
24
Tips and Critical Success Factors
•
•
•
•
•
•
•
Clear aim with an endpoint
Consistent approach of how to get there
Committed Leadership
Engage the people who do the work
Test before implementing
Celebrate the victories along the way
Measure, measure, measure
www.HQOntario.ca
www.HQOntario.ca
In Summary
Use Panel Equation as a starting
point
Supply=Appts/wk X wks
worked/yr
Demand=Roster X revisit rate
Optimize roles of all
team members
(Who can and should be
doing what)
Develop EMR database
consistency starting
with your rostering
process
Monitor TNA on an
ongoing basis - adjust
ratio as needed
New system,
coworkers
Get patient input
often and act upon
feedback
Develop contingency
plans before they are
needed
Reiew Prinicples of
Advanced Access
=
Measure ratio of
&
More time needed at
appointment
new visits:return
visits
Efficiency often
While rostering - use
every other appt. slot
using the in between
slots for return visits
Use Principles of Efficiency
to maximize office
processes
www.HQOntario.ca
(such as Process maps)
Resources
Based on work by Dr. Mark Murray and Associates - MMA
www.HQOntario.ca
www.HQOntario.ca