Improving Access at the Saskatoon Community Clinic

1. Improving Access at the Saskatoon Community Clinic

2. Saskatoon Community Clinic • Citizen sponsored health care co-operative founded 1962 • Multi-disciplinary primary care team with 140 staff working from 3 sites • 13 full time equivalent physician positions/1 nurse practitioner position • 40,000 patient visits; 28,000 patient charts

4. Change Process • There was a lot of “noise” in our patient group about timely access to one’s family physician • Committee struck to review the concern • “Improved Access” model discussed, reviewed and evaluated over 6 month period • Pre-program patient survey administered with support of Health Quality Council • In fall 2004 after careful study introduced “Improved Access” at Main Clinic

5. Patient Care Goals • To meet patient appointment needs within two working days for most types of appointments. • To try as much as possible to have patients see their own family physician rather than another doctor at the Community Clinic.

6. Anticipated Outcomes • More timely access for our patients to their family physician • Reduction of stress for our health care team • Improved patient and staff satisfaction

7. Program Implementation Phases • Exploring the problem and solutions: • Literature review • Mutual learning about the model • Meetings with relevant team players • Participation in Re-designing the Clinical Office Practice conference with support of Health Quality Council • Understanding supply and demand • Shaping the handling of demand • Creating contingency plans • Evaluation and adjustment

8. Evaluation Questions • Is there a change over time in the access of patients to their primary health care provider? • Is there an improvement in patient satisfaction?

9. Evaluation Tools • 3rd available appointment measure • continuous, before intervention and during intervention • Gold standard for measuring wait times • Patient satisfaction questionnaires • British NHS General Practice Assessment Questionnaire (GPAQ) • East Hampshire Primary Care Trust short patient questionnaire • pre-program, mid-program, and post program • Patient self-reports on continuity of care

10. 35 30 25 20 15 10 5 0 Saskatoon Community Clinic Weighted Group Average for Regular Appointments March 2004 compared to March 2005 40 # of days 2004 2005 Year

11. 35 30 25 20 15 10 5 0 Saskatoon Community Clinic Weighted Group Average for Complete Appointments March 2004 compared to March 2005 40 # of days 2004 2005 Year

12. Mid-Cycle Patient Questionnaire 91 % said their appt. was within their timescale 78% saw their own family doctor • Administered for 5 days over 5 week period 6 months after implementation of Improved Access • Completed by 372 patients • Patients asked who the appointment was with, when they asked to be seen, and whether or not this was within their timescale

13. General Practice Assessment Questionnaire (GPAQ) • General Practice Assessment Questionnaires (GPAQ) administered to 350 patients before implementation of Improved Access and one year following implementation • The GPAQ is a tested, reliable measurement instrument, that was developed and is used by the National Health Services (UK) • designed to measure patient satisfaction with various aspects of physician practice including access to care

14. Pre and Post Program GPAQ Scores

15. Next Steps… • Participating in province-wide Health Quality Council Chronic Disease Management Collaborative • Sharing expertise re: Improved Access with 34 other physician practices from across the province • Using our Improved Access capacity to start improving Chronic Disease Management

16. Contacts Saskatoon Community Clinic Ingrid Larson • 664-4243 • ilarson@communityclinic.sk.ca Dr. Carla Eisenhauer • 652-0300 • ceisenhauer@communityclinic.sk.ca Health Quality Council Katherine Stevenson • 668-8810, ext. 107 • kstevenson@hqc.sk.ca