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Advanced Access: How To Make it Work; Part A

Advanced Access: How To Make it Work; Part A. Catherine Tantau, BSN, MPA Tantau & Associates P.O. Box 179 Chicago Park, California 530-273-6550 ct@tantauassociates.com www.tantauassociates.com © Tantau & Associates. Objectives….

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Advanced Access: How To Make it Work; Part A

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  1. Advanced Access:How To Make it Work;Part A Catherine Tantau, BSN, MPA Tantau & Associates P.O. Box 179 Chicago Park, California 530-273-6550 ct@tantauassociates.com www.tantauassociates.com © Tantau & Associates copyright Tantau & Associates

  2. Objectives… • Learn how to balance Demand and Supply using practical, tested approaches • Leave with an understanding of the basic elements of an effective Backlog Reduction plan to close the gap between current delays and your access goals. • Recognize the value of, and strategies for, simplifying appointment types and times. copyright Tantau & Associates

  3. copyright Tantau & Associates

  4. First things first… • Measure Delay for routine appointments and elective procedures • Set an Access aim • Why the Gold Standard? • The strength of organizational aim copyright Tantau & Associates

  5. High Leverage Changes for Access Improvement • Match Demand and Supply Daily • Reduce Backlog • Decrease Appointment Types and Times • Develop Contingency Plans • Reduce Demand for Visits • Optimize the Care Team ©Tantau & Associates copyright Tantau & Associates

  6. Sequencing for Advanced AccessMany options; one example of a tested path • Set Access Aim • Measure delay for routine appt for each provider • Measure Demand and Supply These are not necessarily linear, consider parallel processing… • Empanel patients with a PCP and promote Continuity • Match Demand and Supply, daily • Work down the Backlog !!!!! • Simplify appt types and time • Develop Contingency Plans • Reduce demand for unnecessary visits • Optimize the Care Team • At every step… • Track and display data at least monthly • Celebrate successes and failures! copyright Tantau & Associates © Tantau & Associates

  7. 1.Match Demand and Supply Daily…a review • Make a decision… Carve-out or Advanced? • Improve Continuity using panel information ©Tantau & Associates copyright Tantau & Associates

  8. Demand • Illness Burden of Population • Mood and Attitude • Continuity • Practice Style • Measure: True demand • Demand Drivers: Panel Size, Case load, return visit intervals… © Tantau & Associates

  9. Measuring Appt Demand • Look at historical data?...no • Worse case Scenario… • Reassurance • “real time” data • Moment of Truth: Booking transactions

  10. Demand True Demand Formula: External Appointment requests, called in and appted regardless of day appted to (today or future) + Walk-ins for appts. + Other portals of entry if result in appt booked + Deflections we can count? (UCC ?) Internal + Returns booked today as pt leaves Total Demand

  11. Supply • Macro Supply…dept level • Deployment of Supply…bookable hours • Measures • Measure when schedule is released. • Appts per session for each day of week per provider. • Estimate % long and shorts based on prior schedules • Hours per session ? • Productivity standard? • Office FTE modification • Process of Supply… • What is the work? • Who does the work? • What can we try doing differently?

  12. Activity; the 3rd Dimension • Activity is the measure of patients who were actually seen today. • At the end of the day, regardless of demand or supply, count the number of patients seen. • Accounts for No Shows.

  13. One SF Clinic’s Progress Balancing Demand, Supply, Activity copyright Tantau & Associates

  14. Three Dimensions;Demand, Supply, Activity

  15. How to Track…How long to track… • Tic Marks vs Electronic tracking • 4-6 weeks and then forever • Separating Internal from External © Tantau & Associates

  16. Tracking Appt Demand and Supplysource: YKHC, Bethel Alaska

  17. What’s your situation?How do you know? • D>S ? • D<S ? • D:S ? ------------------------------------------------ • “Our schedules are jammed every day. Our Demand must outstrip our Supply”(??????) • “We’ve had the same Delay for months.” • “We measure D and S, continuously and map the trends.”

  18. If Demand is Greater than Supply • Work harder ? • Delay the work ? • Buy more supply ? • Do the work differently !!! …test…. • Shape Demand • Eliminate duplicate visits • Care Team development; leverage the work • Extend visit interval • Promote Continuity • Max Pack • Simplify Appt types and times • Nurse Appts, phone appts, group appts. • Improve Access to reduce No Shows and capture that Supply • Spread

  19. Identify source of Demand and ask,“Why?” • Internal • External • Discontinuity • Single issue visits to ramp up visit count? • Bumping • Delays and defensive booking • Growth

  20. If Supply is greater than Demand… • Opportunities • Backlog reduction easier • Growth • Challenges • Over supplied if growth not possible • Financial impact

  21. 2. Reduce the Backlog Are we there yet? copyright Tantau & Associates ©Tantau & Associates

  22. Good Backlog vs Bad Backlog copyright Tantau & Associates

  23. copyright Tantau & Associates

  24. Backlog Planning • Assemble your team • Develop a written plan • Set two dates • Who plays??? copyright Tantau & Associates

  25. Backlog Reduction No substitute for hard work, but… copyright Tantau & Associates

  26. Backlog Plan: Smart Strategies • Work backlog as a team • Look ahead at the schedule • Maximize the visit efficiency • Extend visit interval • Manage follow up visits in a different way • Leverage the work to others • Support the team during backlog redux. • Celebrate!!!!! copyright Tantau & Associates © Tantau & Associates

  27. Set Two Dates… • Select a start date • Select an end date copyright Tantau & Associates © Tantau & Associates

  28. Do Increasingly More Of Today’s Work Today • Commit to it! • Don’t add to the end of the queue • Loosen the criteria for “today” copyright Tantau & Associates © Tantau & Associates

  29. Work Backlog As A Team • Commit to continuity for appts • Can someone else on the team manage this problem? • Beware of Negative Reward copyright Tantau & Associates © Tantau & Associates

  30. Look Ahead At The Schedules • Check for duplicate visits and referrals…comb the schedule. • Will a telephone call suffice? Phone appts? SF General Family Medicine testing • Can more be done at today’s visit to eliminate a future visit? copyright Tantau & Associates © Tantau & Associates

  31. Consider This… • A physician sees twenty patients a day for twenty days per month for ten months per year. If s/he is able to maximize one visit to reduce future demand, then this physician has saved 200 visits in a year. That is ten physician days. • If a physician can appropriately extend the visit interval for fifty diabetic patients from three months to four months, then fifty visits are saved per year. That is 2.5 physician days. • Better yet, use members of the Care Team! copyright Tantau & Associates © Tantau & Associates

  32. Maximize Visit Efficiency • Increase the value of the face-to-face clinician/patient time • Eliminate distractions / interruptions • Leverage the providers time (OE) • Do more with some visits copyright Tantau & Associates © Tantau & Associates

  33. Extend The Visit Intervals • Specific patient • Specific diagnosis or care pathway • Eliminate or combine certain return visits copyright Tantau & Associates © Tantau & Associates

  34. Manage Follow-Ups In A New Way • Can an RN or Health Coach follow-up with the patient? • Can an NP or PA manage the care plan? • Phone visit follow-up? • Group visits? • Tickler file reminder vs appt? copyright Tantau & Associates © Tantau & Associates

  35. Sometimes a small change can make a big difference…YKHC Physical TherapyReduction in Delays for Appointments Stopped serial Booking of returns No. of Days Date copyright Tantau & Associates

  36. Hard Strategies • Temporarily add daily capacity • How much, where, when… • Do increasingly more of today’s work today…add less to end of queue • Identify team members roles and responsibilities… copyright Tantau & Associates © Tantau & Associates

  37. Hard Backlog Strategies Add daily capacity • Where? • When? • How? • Some customization is good. • Be clear! copyright Tantau & Associates

  38. Temporarily Add Capacity Not too much… Not too little… Just right! copyright Tantau & Associates © Tantau & Associates

  39. Thoughts To Consider… • Promote team communication…daily huddles, standing agenda item. • Collect data, analyze it, talk about it, share it. • Gain commitment • Support the team • Motivate the staff • Celebrate copyright Tantau & Associates

  40. Cautions… • Backlog reduction is hard work • Prepare for effects on other services • Be careful about “rewarding” the early birds with perverse incentives • Beware the temptation to slide backwards when things get a little better or worse! copyright Tantau & Associates © Tantau & Associates

  41. copyright Tantau & Associates

  42. Example from Swedish Health Care System Nurse-Managed Clinics in charge of schedules, all follow-up visits, searched for every opportunity to remove work from specialist Standardized protocols and pathways beginning with ER (most of their cases came from ER) copyright Tantau & Associates

  43. Annotated Run Chart – Medical College of WI 1 1 2 3 • Extended visit intervals based on actual availability and clinical need • Summer vacation with no contingency plans • New provider began to see patients, Dec. 1 copyright Tantau & Associates

  44. PDSAs: The Wisconsin Experience 1. All patients leave clinic with an appt based on real supply- looked at 3rd next, extended visit intervals where appropriate, considered phone follow-up in place of visits, need for tailored follow up plans 2. Every patient leaves with a follow-up plan copyright Tantau & Associates

  45. YKHC Physical TherapyReduction in Delays for Appointments Stopped serial Booking of returns No. of Days Date copyright Tantau & Associates

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