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(Your Name) – QIC Health Quality Ontario

New Practices and Providers in Primary Care Advanced Access & Efficiency. (Your Name) – QIC Health Quality Ontario. Objectives. To understand: how the principles of Advanced Access and Efficiency relate to new providers/practices

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(Your Name) – QIC Health Quality Ontario

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  1. New Practices and Providers in Primary Care Advanced Access & Efficiency (Your Name) – QIC Health Quality Ontario www.HQOntario.ca

  2. 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

  3. Overview of Advanced Access and Efficiency in New Primary Care Practices www.HQOntario.ca

  4. 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

  5. Principles of Access • Understand and Balance Supply and Demand • Increase Supply • Decrease Demand • Reduce Appointment Times and Types • Reduce Backlog • Develop Contingency Plans www.HQOntario.ca

  6. 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 www.HQOntario.ca

  7. The Panel-Size Equation • Supply = (# Weeks worked/year) X (# appointments/week) • MUST EQUAL • Demand = (# of pts/clients in pane)l X (visit rate) S D www.HQOntario.ca

  8. The Panel-Size Equation (an example) • Supply: (Weeks worked/year) x (appts./week) • 46 x 92 = 4232 • Demand: (Panel Size) x (visit rate) • 1200 x 3.5 = 4200 • This is an example of a balanced practice www.HQOntario.ca

  9. 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 www.HQOntario.ca

  10. 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? www.HQOntario.ca

  11. 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 www.HQOntario.ca

  12. Three Moving Parts • Everyone is getting used to the new system and to each other • New patients require more time at an intake appt. • New patients will generate more follow/ups initially so visit rate will start out higher www.HQOntario.ca

  13. 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 www.HQOntario.ca

  14. 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 www.HQOntario.ca

  15. 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 www.HQOntario.ca

  16. 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. www.HQOntario.ca

  17. 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 www.HQOntario.ca

  18. 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? www.HQOntario.ca

  19. 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 www.HQOntario.ca

  20. Example of a Process Map (during) www.HQOntario.ca

  21. Example of a Process Map(After) www.HQOntario.ca

  22. 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) www.HQOntario.ca

  23. 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 www.HQOntario.ca

  24. 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

  25. 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

  26. 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

  27. www.HQOntario.ca

  28. In Summary www.HQOntario.ca

  29. Resources Based on work by Dr. Mark Murray and Associates - MMA www.HQOntario.ca

  30. www.HQOntario.ca

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