Advanced Access & Office
Efficiency
Learning Session 2
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Welcome back!
 Agenda
 Advanced access key concepts
 Share progress & measures from action period #1
› Revelations in some practices
 Examine delays within the practice
 Introduce and discuss ways to recapture lost capacity within
your practice
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Faculty/Presenter Disclosure
Speaker’s Name: Speaker’s Name
Relationships with commercial interests:
- Grants/Research Support: PharmaCorp ABC
- Speakers Bureau/Honoraria: XYZ Biopharmaceuticals Ltd
- Consulting Fees: MedX Group Inc.
- Other: Employee of XYZ Hospital Group
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Disclosure of Commercial Support
This program has received financial support from [organization name] in the form
of [describe support here – e.g. educational grant].
This program has received in-kind support from [organization name] in the form
of [describe the support here – e.g. logistical support].
Potential for conflict(s) of interest:
- [Speaker/Faculty name] has received [payment/funding, etc.] from
[organization supporting this program AND/OR organization whose product(s) are
being discussed in this program].
- [Supporting organization name] [developed/licenses/distributes/benefits from
the sale of, etc.] a product that will be discussed in this program: [enter generic
and brand name here].
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Mitigating Potential Bias
[Explain how potential sources of bias identified in slides 1 and 2 have been
mitigated].
Refer to “Quick Tips” document
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Collaborative Aim
 The care of patients will be redesigned to improve access,
capacity and efficiency.
 How will the aim be accomplished?
Advanced Access, and Office Efficiency change packages will
be used to decrease the wait time of patients for, and at,
appointments in Primary Care
 How will we know this has been accomplished?
Change will be evidenced by improved 3rd next available
appointment, and improved appointment cycle time.
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Review of Learning Session 1
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Advanced access is “doing today’s work today”
Understand, measure and balance your supply and demand
Reduce your scheduling complexity
Work down your backlog
Develop contingency plans
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Action period report-out
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Tests of change
Successes
Challenges
Measurement
Supply
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Introduction to Office Efficiency
“All systems are perfectly designed to get the results they
get”
- W. Edwards Deming
“I had to think about this for awhile before I jumped in. I
realized everything in medicine has changed steadily.
We are constantly looking for better ways to diagnose
and treat patients. But, office flow has stayed the same
for 50 year. It is about time we pay attention to it.”
- Dr. Patrick Macken, Nephrologist
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Aim
 To reduce delays at an appointment
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Benefits of Improved Office Efficiency
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Appointments start and end on time
Work days start and end on time
Office visit is optimized; patient-provider time protected
Rework and duplication of work is decreased, thereby increasing
capacity
 Experience of patient, staff and provider is improved
 Costs/visit are decreased
 Income is increased
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Measure of Office Efficiency
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Cycle Time
From time of “check-in”, until time of “check-out”
Gain insight into possible bottlenecks in practice processes
Assess your practice, from patient’s perspective
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Patient flow through the office
Patient enters
Wait
Registration
Wait
Exam Room
Wait
Provider-Patient Interaction
Wait
Completion of
procedures/orders
Wait
Checkout
Non-appointment
time =
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Pre-Red
Zone
Cycle time
Red Zone
Post-Red
Zone
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Patient flow through the office
Patient enters
Registration
Exam Room
Provider-Patient Interaction
Completion of
procedures/orders
Checkout
Non-appointment16time =
Pre-Red
Zone
Cycle time
Red Zone
Post-Red
Zone
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Measuring cycle time
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Key Concepts of
Office Efficiency
 Predict and anticipate
care needs
› Streamline work
and standardize
where possible
 Optimize the care
team
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1. Predict and Anticipate Needs
Know the work:
 Knowing what you do (know your processes)
 Knowing how it happens (flow mapping)
 Knowing how often it happens (measures)
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“Know Your Processes”
Activity
 Each person completes the form
 Discuss results with your team
 Identify 1-3 areas for improvement
 Identify potential strategies
 Debrief as a large group
You have 20 minutes for this activity
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Break
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Process Mapping
 What is a “process”?
› A series of connected steps or actions with an
identifiable start and end point
› Leads to a specific outcome
 Why map a process?
› It illustrates “how things work in our practice”
› Includes several perspectives
› Starting point for improvement
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Process Mapping
 Oval - the start and end of the
process
 Box - the tasks or activities of the
process
 Diamond - a question is asked; a
decision is required
 Arrow - the direction or flow of the
process
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Example
Steps:
 Patient enters room for appt. (start)
 Provider enters room
 Provider discusses Pt’s needs
 Provider examines Patient
 Provider IDs need for urine specimen
 Patient given specimen cup
 Provider completes paperwork
 Follow-up instructions given to Patient
 Patient leaves (end)
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Patient
enters
room for
appt
Provider enters
room
Provider
discusses
patient’s needs
Provider
examines patient
Provider IDs
need for urine
specimen
Patient given
specimen cup
Provider
completes
paperwork
Follow-up
instructions
given to patient
Patient
leaves
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Process Mapping Activity
Please pick one process in your office and map it
You have 20 minutes for this activity
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Table Discussion
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Where are the hand-offs in the process?
Is it clear who does what?
Where are the delays?
Is there duplication or rework?
Are there identifiable areas where a small change could make
an improvement?
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2. Optimize the Practice Care Team
 Who does what?
 Who could do what?
 Who should do what?
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Activity
 Review the measurement tools
 Review your schedule
 Assess backlog
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The Practice team …
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Is pro-active instead of reactive
Knows, trusts, supports and values each other
Communicates with each other, does not feel isolated
Is accountable to each other and to the patient
Uses measures for feedback and to guide improvement
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Daily Huddles
 A brief (5-10 mins) meeting to:
› review schedule
› deal with issues left over
from previous day
› anticipate needs for current day
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Other Ideas, Strategies and/or Tools
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Reason for visit card
Scripts – greeting, booking, reason for visit
Standardization – checklists, policies, exam room stocks
Interruptions log
Patient experience survey
Track start/end times
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The Model For Improvement
› What are we trying to accomplish?
› How do we know change is an improvement?
› What changes can we make that will result in an
improvement?
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Model for Improvement
What are we trying to
accomplish?
How will we know that a
change is an improvement?
What changes can we make that
will result in improvement?
Act
Plan
Study
Do
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Where do I start?
 What are you going to do
next Tuesday?
 What is your aim?
 Determine how you will
measure/track
improvement
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Action Period #2
 Implement small tests of change
 Measure and track
 RST support
 Continue to work toward your access aim
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Good Luck!
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