Advanced Access Advanced Access AppointmentsAppointments

Paul Cano MD, FCFPPaul Cano MD, FCFP

Smithville Family Health TeamSmithville Family Health Team

May 6, 2011May 6, 2011

Smithville Family Health Smithville Family Health TeamTeam• 8 family physicians 8 family physicians

(5.5 FTE)(5.5 FTE)• Serves a rural area of Serves a rural area of

West Lincoln West Lincoln TownshipTownship

• ~ 10000 patients~ 10000 patients• All MD’s serve at All MD’s serve at

WLMH in GrimsbyWLMH in Grimsby• Teaching practice Teaching practice

(McMaster)(McMaster)

Smithville Family Health Smithville Family Health TeamTeam

Staff:Staff:• 6 RN/RPN, 3 FTE6 RN/RPN, 3 FTE

• 6 Secretaries, 4 FTE6 Secretaries, 4 FTE

• 1 Office Manager1 Office Manager

• 4 Scanning, 2 FTE4 Scanning, 2 FTE

• IT support, 1 FTEIT support, 1 FTE

• Clean/stock ½ FTEClean/stock ½ FTE

FHT:FHT: 2 RN’s, 2 NP’s, 2 MH, 1 Dietician, 1 admin,2 RN’s, 2 NP’s, 2 MH, 1 Dietician, 1 admin,

½ secretary½ secretary

The Problem…The Problem…

Waiting times for appointments for:Waiting times for appointments for:- today’s appointmentstoday’s appointments after they after they

fill up (“Call tomorrow at 9AM…”)fill up (“Call tomorrow at 9AM…”)- urgent apptsurgent appts to see pts own FP (“I to see pts own FP (“I

don’t have anything with Dr. Cano for don’t have anything with Dr. Cano for 2 weeks, but I can offer you …’)2 weeks, but I can offer you …’)

- physicalsphysicals (“Dr. Cano is booking 3 (“Dr. Cano is booking 3 months from now”)months from now”)

The Problem…The Problem…

Canada is the worst country in the Canada is the worst country in the Commonwealth for being able to get Commonwealth for being able to get an appointment in the next 24 hours an appointment in the next 24 hours (39% vs. 50-75%)(39% vs. 50-75%)

The Problem compounds …The Problem compounds …

• Receptionists are forced to ‘triage’ the problemReceptionists are forced to ‘triage’ the problem• They spend 5 times longer on the phone with the They spend 5 times longer on the phone with the

patientpatient• ‘‘Queue jumping’ – pts learn what to do to get in Queue jumping’ – pts learn what to do to get in

quicker (crying, suicidal, short of breath)quicker (crying, suicidal, short of breath)• Pts get care elsewhere in meantime, then 50% Pts get care elsewhere in meantime, then 50%

see you anyway (“I kept this appt because ...”, see you anyway (“I kept this appt because ...”, then you get to review the other visits)then you get to review the other visits)

• Seeing pts that are not your own results in longer Seeing pts that are not your own results in longer visitsvisits

• No shows when the appt finally comes aroundNo shows when the appt finally comes around

Complexity of ScheduleComplexity of Schedule

• We had several different appointment types We had several different appointment types — Physicals, WBV/PN, Urgent, ER— Physicals, WBV/PN, Urgent, ER

• We had multiple rules about these We had multiple rules about these appointment types:appointment types:

• E.g. 2 physicals / half day, except not 2 E.g. 2 physicals / half day, except not 2 female physicals as they generally take female physicals as they generally take longer, except if the female is youngerlonger, except if the female is younger

• The schedule worked well some days if … I The schedule worked well some days if … I or my secretary or my nurse looked ahead or my secretary or my nurse looked ahead and rearranged a future day where the and rearranged a future day where the appts didn’t look like a good mix, calling appts didn’t look like a good mix, calling patients to change their timespatients to change their times

What Is Advanced What Is Advanced Access?Access?

• Also called ‘Open Access’Also called ‘Open Access’

• A method of adding capacity to a A method of adding capacity to a practice by not booking aheadpractice by not booking ahead

• In it’s pure form, patients call and In it’s pure form, patients call and are seen the same dayare seen the same day

Where Did it Come Where Did it Come From?From?

• Pioneered by Dr. Mark Murray, a Pioneered by Dr. Mark Murray, a family physician with Kaiser family physician with Kaiser Permanente in CaliforniaPermanente in California

• Taken from Best Practice in IndustryTaken from Best Practice in Industry

• Used in HMO’s to increase # of Used in HMO’s to increase # of patients that can be served without patients that can be served without increasing staffincreasing staff

The Philosophy…The Philosophy…

• Do Today’s Work TodayDo Today’s Work Today

• Although demand for services is Although demand for services is variable, it is also predictablevariable, it is also predictable

• Don’t make things more complex Don’t make things more complex than they need to bethan they need to be

Reduce Appointment TypesReduce Appointment Types

With the goal to do today's work today, the With the goal to do today's work today, the distinction between urgent and routine is distinction between urgent and routine is no longer necessary. The only no longer necessary. The only distinctions between appointment types distinctions between appointment types needed are: needed are:

• Provider is present vs. provider is absent Provider is present vs. provider is absent

• A short appointment type for return visits A short appointment type for return visits

• A long appointment type for physicals A long appointment type for physicals and new ptsand new pts

Reduce Appointment TypesReduce Appointment Types

• When the provider is present the patient is When the provider is present the patient is seenseen

• When the provider is absent the patient is When the provider is absent the patient is offered the choice of an appointment the next offered the choice of an appointment the next time the provider is present or today with time the provider is present or today with another care team memberanother care team member

• All other special appointment types, such as All other special appointment types, such as for disease entity or physicals by age groups, for disease entity or physicals by age groups, can be eliminated. can be eliminated.

• Reducing appointment types simplifies Reducing appointment types simplifies telephone appointment triage, allows more telephone appointment triage, allows more flexibility for patients, and reduces queuingflexibility for patients, and reduces queuing

Commit to Doing Today’s Work Commit to Doing Today’s Work TodayToday

• In clinics with this system, the only In clinics with this system, the only appointments that are on the books at the appointments that are on the books at the beginning of each day are the return beginning of each day are the return appointments that were generated by appointments that were generated by physician discretion or patient preference on physician discretion or patient preference on a previous daya previous day

• There are no "frozen" or held appointment There are no "frozen" or held appointment slots, as this provides maximum flexibility in slots, as this provides maximum flexibility in the system to absorb daily demand. the system to absorb daily demand.

• It has 2 requirements:It has 2 requirements:-- supply and demand are in balancesupply and demand are in balance, and , and -- that the that the backlog is eliminatedbacklog is eliminated

Who has done it?Who has done it?

• USA HMO’s such as KPUSA HMO’s such as KP

• UK practices in a quality initiativeUK practices in a quality initiative

• Taber Alberta, Cape BretonTaber Alberta, Cape Breton

• Ontario practices: Cambridge Ontario practices: Cambridge Grandview, Chatham Tilbury, Grandview, Chatham Tilbury, Burlington Caroline, Toronto New Burlington Caroline, Toronto New Heights CHC, WawaHeights CHC, Wawa

ResultsResults

• Taber (Alberta) – decreased asthma Taber (Alberta) – decreased asthma visits to ER by 33%visits to ER by 33%

• New Heights (Toronto) – average New Heights (Toronto) – average wait from 30 days to <8hrs for same wait from 30 days to <8hrs for same dayday

ResultsResults

• No showsNo shows – New Heights reduced – New Heights reduced rate from 23.5% to 15%rate from 23.5% to 15%

- Nottingham reduces from - Nottingham reduces from 160/month to 20/month160/month to 20/month

• Capacity Capacity – New Heights increased – New Heights increased the number of pt encounters by 41% the number of pt encounters by 41% over 14 monthsover 14 months

Advanced AccessAdvanced Access

• ““Heard it through the grapevine”Heard it through the grapevine”

• Learned the specifics through a Learned the specifics through a Quality initiative our practice joined Quality initiative our practice joined (‘QIIP’)(‘QIIP’)

My “3rd next appt” – Summer My “3rd next appt” – Summer 20092009

Average Time to 3rd Next Available Appointment by Provider

0.0

20.0

40.0

60.0

80.0

100.0

Apr-09

May-09

Jun-09

Jul-0

9

Aug-09

Sep-09

Oct-09

Nov-09

Dec-09

Jan-10

Feb-10

Mar-10

Apr-10

May-10

Jun-10

Jul-1

0

Aug-10

How to ImplementHow to Implement

• Get buy in from your staffGet buy in from your staff

• Measure your supply and your demandMeasure your supply and your demand

• Analyze patterns of usageAnalyze patterns of usage

• Plan your schedules and processes Plan your schedules and processes based on your own databased on your own data

• Set a start dateSet a start date

• Work down the backlogWork down the backlog

How we StartedHow we Started

• Got staff to ‘buy in’Got staff to ‘buy in’• Measured supply and demand, Measured supply and demand,

determined that my current schedule determined that my current schedule can meet demandcan meet demand

• Started in summer 2009, and set a Started in summer 2009, and set a date 3 months in advance (Oct 1date 3 months in advance (Oct 1stst) as ) as a start date (this was where my a start date (this was where my ‘physicals’ were booked up until)‘physicals’ were booked up until)

Measuring Supply and DemandMeasuring Supply and Demand

• Supply: When you are available for Supply: When you are available for patient appointmentspatient appointments

• Daily Demand: appointment requests Daily Demand: appointment requests each dayeach day

• Demand is both ‘external’ (patient Demand is both ‘external’ (patient initiated), and ‘internal’ (provider initiated), and ‘internal’ (provider initiated)initiated)

• Got staff to measureGot staff to measure

Data Collection ChallengesData Collection Challenges

• Multiple secretariesMultiple secretaries

• Differing commitment to the goalsDiffering commitment to the goals

• Better buy in after I had Better buy in after I had implemented it successfullyimplemented it successfully

• ?easier to collect for all docs, not just ?easier to collect for all docs, not just 11

Demand MeasuresDemand Measures

• My practice is 1450, about 85% My practice is 1450, about 85% rosteredrostered

• Actual total demand – weekday average Actual total demand – weekday average is:is:12.6 measured pre AA (15.4 measured 12.6 measured pre AA (15.4 measured post AA – more accurate)post AA – more accurate)

• Internal / External demand proportionInternal / External demand proportion34 + 66% 34 + 66% before before Advanced AccessAdvanced Access20 + 80% 20 + 80% afterafter AA AA

Demand Estimates – ICESDemand Estimates – ICES

• Based on measured annual visit rates of age Based on measured annual visit rates of age groups in Ontario (0-1, 1-4, 5-9, etc.)groups in Ontario (0-1, 1-4, 5-9, etc.)

• Sept 2007 – Aug 2008Sept 2007 – Aug 2008• Includes patient visits to all primary care Includes patient visits to all primary care

physicians, not just their own family docphysicians, not just their own family doc• Includes walk-in clinicsIncludes walk-in clinics• Excludes ER visits Excludes ER visits • Does not include non-rostered patientsDoes not include non-rostered patients• Separate estimates for FHT, FHO, FHN, Separate estimates for FHT, FHO, FHN,

FHG,FFSFHG,FFS

Demand Estimates – ICESDemand Estimates – ICES

• Used my total practice number (not just Used my total practice number (not just rostered patients)rostered patients)

• Plugged numbers in to the spreadsheetPlugged numbers in to the spreadsheet

• 3,791 visits/year / 46*53,791 visits/year / 46*5

= an average of 16.48 visits/weekday= an average of 16.48 visits/weekday

• An overestimate as based on total visits An overestimate as based on total visits to ALL GP’s (so perhaps useful…)to ALL GP’s (so perhaps useful…)

Matching My Supply to Matching My Supply to DemandDemand

My weekly schedule:My weekly schedule:

• Monday AMMonday AM

• Tuesday EveTuesday Eve

• Thursday AMThursday AM

• Thursday PMThursday PM

• Friday AM or PMFriday AM or PM

My weekly demandMy weekly demand

• Monday – 19 (23)Monday – 19 (23)

• Tuesday – 12 (16)Tuesday – 12 (16)

• Wednesday – 10 (8)Wednesday – 10 (8)

• Thursday – 13 (18)Thursday – 13 (18)

• Friday – 10 (12)Friday – 10 (12)

• Average – 12.6 Average – 12.6 (15.4)(15.4)

Matching My Supply to Matching My Supply to DemandDemand

My weekly schedule:My weekly schedule:

• Monday AM (16)Monday AM (16)

• Tuesday Eve (16)Tuesday Eve (16)

• Thursday AM (16)Thursday AM (16)

• Thursday PM (12)Thursday PM (12)

• Friday AM or PM (16)Friday AM or PM (16)

My weekly demandMy weekly demand

• Monday – 19 (23)Monday – 19 (23)

• Tuesday – 12 (16)Tuesday – 12 (16)

• Wednesday – 10 Wednesday – 10 (8)(8)

• Thursday – 13 (18)Thursday – 13 (18)

• Friday – 10 (12)Friday – 10 (12)

• Average – 13 (15)Average – 13 (15)

Matching Supply to DemandMatching Supply to Demand

• Supply was about right for 16 visits / Supply was about right for 16 visits / dayday

• Bookings changed from 10 minute Bookings changed from 10 minute intervals with lots of precoding, to 15 intervals with lots of precoding, to 15 minutes intervals with little minutes intervals with little precodingprecoding

Contingency Plan for Contingency Plan for VacationsVacations

• Plan in advancePlan in advance

• Measure the length of vacationMeasure the length of vacation

• Don’t prebook anything (if possible) for an Don’t prebook anything (if possible) for an equal length of time after the vacation equal length of time after the vacation ends (call it the ‘vacation recovery ends (call it the ‘vacation recovery period’)period’)

• The vacation recovery period opens up to The vacation recovery period opens up to appointments once the vacation startsappointments once the vacation starts

Staff TrainingStaff Training

• Initial meeting to outline concept, set start Initial meeting to outline concept, set start date, and establish ‘rules’ (as little rules as date, and establish ‘rules’ (as little rules as possible!)possible!)

• Explained my new schedule: now 4 slots / Explained my new schedule: now 4 slots / hour, from a previous 5-6 / hour (15 minutes hour, from a previous 5-6 / hour (15 minutes slots vs. 10 minute slots)slots vs. 10 minute slots)

• Initial Rules: limits on number of appts to be Initial Rules: limits on number of appts to be prebooked each dayprebooked each day- what can and couldn’t be prebooked (later - what can and couldn’t be prebooked (later relaxed this, let them prebook if they wanted relaxed this, let them prebook if they wanted to)to)- 2 slots for CPX, everything else 1 slot- 2 slots for CPX, everything else 1 slot

Sent a Letter to PatientsSent a Letter to Patients

• A lot of work (review of roster)A lot of work (review of roster)

• It did save my time in explaining to It did save my time in explaining to patients at end of visits when patients at end of visits when questions about when / if to rebookquestions about when / if to rebook

Letter To My Patients …Letter To My Patients …

I would like to let you know about an exciting change in my I would like to let you know about an exciting change in my medical practice that will be taking place over the medical practice that will be taking place over the upcoming months! Please feel free to share the upcoming months! Please feel free to share the information with any of your family members or friends who information with any of your family members or friends who may also be patients of mine.may also be patients of mine.

‘‘Advanced Access’ for Appointment BookingsAdvanced Access’ for Appointment BookingsStarting on October 1st, I will be keeping about 2/3rd’s of my Starting on October 1st, I will be keeping about 2/3rd’s of my

appointments each day open for booking either that day, or appointments each day open for booking either that day, or the day before. As a result, the number of ‘pre-booked’ the day before. As a result, the number of ‘pre-booked’ appointments (appointments that can be booked well in appointments (appointments that can be booked well in advance) will be limited to about 1/3rd of that day’s advance) will be limited to about 1/3rd of that day’s appointment slots. The idea behind this new booking appointment slots. The idea behind this new booking method (known as ‘Advanced Access’) is to make myself method (known as ‘Advanced Access’) is to make myself more available to you on the day that you call in for an more available to you on the day that you call in for an appointment. appointment.

Working down my backlogWorking down my backlog

• I added 2-3 extra half days over the I added 2-3 extra half days over the 3 months3 months

• There should be no ‘unmet demand’ There should be no ‘unmet demand’ when advanced access startswhen advanced access starts

Working down my backlog Working down my backlog "Max-Packing""Max-Packing"

• "Max-packing" is doing as much for "Max-packing" is doing as much for patients while they are in the office for patients while they are in the office for any given visit, in order to reduce future any given visit, in order to reduce future workwork

• I always did this somewhat, as I was lousy I always did this somewhat, as I was lousy at being assertive with patients (“I can’t at being assertive with patients (“I can’t deal with that problem today …”)deal with that problem today …”)

• RN looked ahead in the schedule, if RN looked ahead in the schedule, if multiple appointments we tried to do multiple appointments we tried to do everything todayeverything today

• long days!long days!

Working down my backlogWorking down my backlog

• Utilize team ‘huddles’ at the start of Utilize team ‘huddles’ at the start of each day to plan for the day ahead.each day to plan for the day ahead.

Other Implementation Other Implementation DetailsDetails

• Some appts can/should still be prebooked Some appts can/should still be prebooked (WBV, PN, dementia, mental health, (WBV, PN, dementia, mental health, chronic pain)chronic pain)

• We eventually allowed any prebooking We eventually allowed any prebooking with just encouragement to book at last with just encouragement to book at last minuteminute

• Still need to leave ½ day open for practice Still need to leave ½ day open for practice ERER

• Frequent FlyersFrequent Flyers

Now, here is a typical week’s schedule Now, here is a typical week’s schedule before the week begins …before the week begins …

Monday October Monday October 19th19th

Tuesday October Tuesday October 20th20th

Thursday Thursday

October 22ndOctober 22nd

Friday Friday

OctoberOctober

23rd23rd

And, here is a schedule in ‘real time’ …And, here is a schedule in ‘real time’ …

Tuesday October 13Tuesday October 13thth

9 AM9 AM

Tuesday October 13Tuesday October 13thth

10 AM10 AM

Tuesday October 13Tuesday October 13thth

End of clinicEnd of clinic

Contingencies ….Contingencies ….

SuSun n 1/41/4

MonMon TuesTues WedWed ThurThurss

FriFri SatSat

1/41/4

7-97-9 Hosp Hosp rndsrnds

Hospital Hospital rounds / rounds / out out patientpatient

Hospital Hospital roundsrounds

Hospital Hospital roundsrounds

HospitaHospital l roundsrounds

9-19-1 ClinicClinic RN HomeRN Home

House House CallsCalls

OffOff ClinicClinic ClinicClinic ClinicClinic

1-51-5 Admin, Admin, IT, IT, forms, forms, phone phone callscalls

Resident Resident

ClinicClinicClinicClinic IT, IT,

forms, forms, phone phone callscalls

5-95-9 ClinicClinic Emerg Emerg ShiftShift

““Conference”Conference”Vancouver, Feb 2010Vancouver, Feb 2010

Conference DelegatesConference Delegates

Back in Smithville …Back in Smithville …

Networking …Networking …

Back in Smithville …Back in Smithville …

Trauma DemonstrationsTrauma Demonstrations

Back at WLMH …Back at WLMH …

Small Group WorkshopsSmall Group Workshops

Back in Smithville …Back in Smithville …

Dermatology …Dermatology …

Back at WLMH …Back at WLMH …

Groundbreaking Study Groundbreaking Study AnnouncementAnnouncement

Face the MusicFace the Music

I return from holiday …I return from holiday …

Anecdotal FeedbackAnecdotal Feedback

• Patients – is this going to last ?Patients – is this going to last ?

• Front Desk – love it!Front Desk – love it!

• I feel I am meeting my patients I feel I am meeting my patients needs betterneeds better

• No shows much less (was 28 / month, No shows much less (was 28 / month, now 6 per month)now 6 per month)

• I am too available to other’s patients!I am too available to other’s patients!

PC – Average waiting timesPC – Average waiting times(“3(“3rdrd next appointment) next appointment)

PC

0

20

40

60

80

100

Apr-09

May-09

Jun-09

Jul-0

9

Aug-09

Sep-09

Oct-09

Nov-09

Dec-09

Jan-10

Feb-10

Mar-10

Apr-10

May-10

Jun-10

Jul-1

0

Aug-10

Sep-10

Oct-10

Nov-10

Dec-10

Jan-11

Feb-11

Mar-11

Apr-11

No Shows / monthNo Shows / month

PC

0

5

10

15

20

25

30

1 3 5 7 9 11 13 15 17 19 21 23 25

Month

# N

o S

ho

ws

PC

IncomeIncome

• No changeNo change

• ?impact on pure FFS models??impact on pure FFS models?

PC = # of my pts appts in the PC = # of my pts appts in the office that are with meoffice that are with me

Physician Continuity

0.0

20.0

40.0

60.0

80.0

100.0

Apr-09

May-09

Jun-09

Jul-0

9

Aug-09

Sep-09

Oct-09

Nov-09

Dec-09

Jan-10

Feb-10

Mar-10

Apr-10

May-10

Jun-10

Jul-1

0

Aug-10

Where did we go from Where did we go from there?there?

• Presented this information to Presented this information to physician retreat in the first monthphysician retreat in the first month

• Are any interested in a ‘second wave’ Are any interested in a ‘second wave’ of changing to Advanced Access? of changing to Advanced Access?

• 3 said yes3 said yes• 2 said maybe2 said maybe• 2 said no2 said no• As of May 2011, 7 of 8 MD’s on AAAs of May 2011, 7 of 8 MD’s on AA

JB (1400) – 3 days/wk, OB, ERJB (1400) – 3 days/wk, OB, ER (“3(“3rdrd next appointment) next appointment)

JB

0

20

40

60

80

100

Apr-09

May-09

Jun-09

Jul-0

9

Aug-09

Sep-09

Oct-09

Nov-09

Dec-09

Jan-10

Feb-10

Mar-10

Apr-10

May-10

Jun-10

Jul-1

0

Aug-10

Sep-10

Oct-10

Nov-10

Dec-10

Jan-11

Feb-11

Mar-11

Apr-11

KB (1105) – 3 days/wkKB (1105) – 3 days/wk (“3(“3rdrd next appointment) next appointment)

KB

0

20

40

60

80

100

Apr-09

May-09

Jun-09

Jul-0

9

Aug-09

Sep-09

Oct-09

Nov-09

Dec-09

Jan-10

Feb-10

Mar-10

Apr-10

May-10

Jun-10

Jul-1

0

Aug-10

Sep-10

Oct-10

Nov-10

Dec-10

Jan-11

Feb-11

Mar-11

Apr-11

MD (1070)– 3 days/wk MD (1070)– 3 days/wk (“3(“3rdrd next appointment) next appointment)

Returned Oct 09 ‘early’ from surgical leave, Returned Oct 09 ‘early’ from surgical leave, locum overlapped by 1 month as she worked locum overlapped by 1 month as she worked part timepart time

MD

0

20

40

60

80

100

Apr-09

May-09

Jun-09

Jul-0

9

Aug-09

Sep-09

Oct-09

Nov-09

Dec-09

Jan-10

Feb-10

Mar-10

Apr-10

May-10

Jun-10

Jul-1

0

Aug-10

Sep-10

Oct-10

Nov-10

Dec-10

Jan-11

Feb-11

Mar-11

Apr-11

MNW (1360)– 4 days/wk, ERMNW (1360)– 4 days/wk, ER (“3(“3rdrd next appointment) next appointment)

MNW

0

20

40

60

80

100

Apr-09

May-09

Jun-09

Jul-0

9

Aug-09

Sep-09

Oct-09

Nov-09

Dec-09

Jan-10

Feb-10

Mar-10

Apr-10

May-10

Jun-10

Jul-1

0

Aug-10

Sep-10

Oct-10

Nov-10

Dec-10

Jan-11

Feb-11

Mar-11

Apr-11

SS (930)– 3 days/wk, ERSS (930)– 3 days/wk, ER (“3(“3rdrd next appointment) next appointment)

Mat Leave locum from July 10 to Mar 11Mat Leave locum from July 10 to Mar 11

Returned April 11 (pts were told May 11)Returned April 11 (pts were told May 11)

SS

0

20

40

60

80

100

Apr-09

May-09

Jun-09

Jul-0

9

Aug-09

Sep-09

Oct-09

Nov-09

Dec-09

Jan-10

Feb-10

Mar-10

Apr-10

May-10

Jun-10

Jul-1

0

Aug-10

Sep-10

Oct-10

Nov-10

Dec-10

Jan-11

Feb-11

Mar-11

Apr-11

TS (1440)– 3 days/wk, GPA, OB TS (1440)– 3 days/wk, GPA, OB

(“3(“3rdrd next appointment) next appointment)

TS

0

20

40

60

80

100

Apr-09

May-09

Jun-09

Jul-0

9

Aug-09

Sep-09

Oct-09

Nov-09

Dec-09

Jan-10

Feb-10

Mar-10

Apr-10

May-10

Jun-10

Jul-1

0

Aug-10

Sep-10

Oct-10

Nov-10

Dec-10

Jan-11

Feb-11

Mar-11

Apr-11

AM (1140) – 3 days/wk, OBAM (1140) – 3 days/wk, OB (“3(“3rdrd next appointment) next appointment)

Just went on Mat leave, will hopefully return Just went on Mat leave, will hopefully return to AA with help of locumto AA with help of locum

AM

0

20

40

60

80

100

Apr-09

May-09

Jun-09

Jul-0

9

Aug-09

Sep-09

Oct-09

Nov-09

Dec-09

Jan-10

Feb-10

Mar-10

Apr-10

May-10

Jun-10

Jul-1

0

Aug-10

Sep-10

Oct-10

Nov-10

Dec-10

Jan-11

Feb-11

Mar-11

Apr-11

SummarySummary

• Advanced access works!Advanced access works!- reduces 3- reduces 3rdrd next appointment next appointment- reduces no-shows- reduces no-shows- reduces demand- reduces demand

• Get buy inGet buy in• Measuring demand labourious but helpfulMeasuring demand labourious but helpful• Estimating demand by ICES may be a Estimating demand by ICES may be a

short cutshort cut• Varying expectations of what ‘open’ is to Varying expectations of what ‘open’ is to

suite your practicesuite your practice

References and References and ResourcesResources

• Murray M, Tantau C. “Same-Day Appointments: Murray M, Tantau C. “Same-Day Appointments: Exploding the Access Paradigm”. Exploding the Access Paradigm”. Family Practice Family Practice ManagementManagement. 2000, September.. 2000, September.

• http://www.chsrf.ca/other_documents/pdf/Promisihttp://www.chsrf.ca/other_documents/pdf/Promising%20Practices_%20Advance%20Access%20ENGng%20Practices_%20Advance%20Access%20ENG_FINAL.pdf_FINAL.pdf

• www.clinicalmicrosystem.org/access.htmwww.clinicalmicrosystem.org/access.htm• McCollum, WRK. “Improving Access in primary McCollum, WRK. “Improving Access in primary

Care - The Advanced Access methodology”. Care - The Advanced Access methodology”. www.salt.n-i.nhs.ukwww.salt.n-i.nhs.uk Oct 10, 2009, Oct 10, 2009,

• www.ihi.orgwww.ihi.org• www.qualityhealthcare.orgwww.qualityhealthcare.org

Thanks!!Thanks!!

canop@mcmaster.cacanop@mcmaster.ca