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www.HQOntario.ca
Advanced Access, Efficiency and Chronic Disease Management in Primary Healthcare
Date:
Name of Presenter:
WAVE 6
2
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
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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.
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Accessible Care
“People are able to get the right care at the right time in the right setting by the right
health-care provider”
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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
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Delays are common in our system:
Del
ay
Getting to GP
Del
ay
Getting Tests
Del
ay
Seeing Specialist
Dissatisfaction, adverse clinical outcomes, increased costs
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• 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?
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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
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“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
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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
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Moving Towards Advanced Access
Access to care can be improved….
By understanding and balancing your Demand and Supply
Demand (From your panel)
Supply (By your care team)
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First, consider your annual Demand & Supply
• How many appointments are requested by your patients in a year?
Panel size x revisit rateDemand
• How many appointments do you offer in a year?
Appointments/week x weeks worked/year Supply
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Next, measure your Demand and Supply on a daily basis
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Demand
• How many people ask for an appointment each day?
ExternalDemand
Internal Demand
Mon
Tues
Wed
Thurs
Fri I I I I I I 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 I I
I I I I I
I I I I I I
I I I I
From your panel
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Supply By your care team
• How many
appointments are
offered each day?
Total Demand
Supply
Mon #
Tues #
Wed #
Thurs #
Fri #
#
#
#
#
#
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• 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 Gatewaywww.hqolc.ca
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Once the care team has balanced Supply & Demand… Reduce your backlog How large
is your backlog?
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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
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Going forward, offer Supply that matches Demand
=
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Maintaining Access requires matching supply to demand – daily & weekly
ExternalDemand
Internal Demand
Mon # #
Tues # #
Wed # #
Thurs # #
Fri # #
# # # # #
#
# # #
#
Mon Tues Wed Thurs Fri
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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
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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
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Case Studies with Advanced Access
Month 1 Month 2 Month 3 Month 4 Month 5 Month 6 Month 7 Month 80
5
10
15
20
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MD1 MD2 MD3
Days
till
3rd
next
Ava
ilabl
e Ap
pt
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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
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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
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Challenges
• Measurement
• Engaging staff
• Change
• Sustainability and Spread
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Learning Community: 3 Main Elements
•Model for Improvement, CDPM Framework
•Clinical Practice, Evidence-based GuidelinesActive Learning
Cycles
•A virtual on line real-time workspace
Infrastructure Gateway
• QI coachSupport
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Benefits of a Learning Community:
• Learn
• Share
• Innovate
• Improve
Learn
Share
Innovate
Improve
Learning Communit
y
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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
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Wave 6 Highlights
• Starts March 20th, 2013
• 9 month + 3 months data collection
• Apply until March 1st, 2013
• Readiness assessment required• Coach support by stream• Team obligations
WAVE 6
www.HQOntario.ca
www.HQOntario.ca
