Jo-Anne Lutz is the Director, Primary Care Clinics, Northern Health Region at the Burntwood Community Health Resource Centre, Thompson, Manitoba
Advanced Access is a frequently misunderstood term. It is a comprehensive approach to effective patient care delivery built on the principles of access improvement and office efficiency. There are many benefits that come with same-day access in primary care. The goal is to start your day on time and end your day on time. Patients receive timely care and benefits associated with seeing their family physician or nurse practitioner.
Advanced Access is not a scheduling system. The goal is same day access; however, patients can book anytime into the future at their convenience. There are several mantras with Advanced Access. “See your own and don’t make them wait” is an integral part of this concept where “continuity is king.”
Advanced Access is not about working longer, harder or faster. It is not about adding more patients into already full schedules. It is about doing work differently. Think of it as resetting the system. Consider a paradigm shift in how health care is provided. Advanced Access is built on the premise of pulling work into today to save tomorrow. This is different than the traditional model of pushing work into the future. Various articles have been written on advanced access however not all have been written from this perspective, a true Advanced Access viewpoint.
There are six principles to access improvement and five principles of office efficiency. Access improvement includes: understanding and balancing supply and demand; reducing backlog, decreasing demand, developing contingency plans; reducing appointment times and types; and optimizing the care team. Office efficiency incorporates the principles of: understanding and balancing supply and demand for non-appointment work; synchronizing patient, provider and equipment; optimizing the environment; managing constraints; and predicting and anticipating needs.
The improvement journey takes time and will use existing resources. Improvement activities are intended to become part of our work, not a distraction from our work.
Advanced Access : Drain the Bathtub and Track Demand
The first step to same-day access is to understand and balance supply and demand. Consider your clinic’s panel of patients as a bathtub spout. The bathtub is filled with virtual patients waiting for their appointments. How long your patients wait for an appointment will correspond with how full your bathtub is. As patients attend their appointment they “drain” out of the bathtub. If you would like to see them again though, they return to the virtual bathtub. This is an important concept. The goal is to “drain your bathtub.”
The people waiting in the bathtub often generate additional work for the clinical setting. They may call multiple times looking for an earlier appointment. Clinics then create cancellation lists and other means, spending time and effort in maintaining these, in an attempt to provide more timely care. The longer a patient waits for an appointment, the greater the chance they will not show for their appointment. This is due to several reasons: they may forget about their appointment, their problem may resolve, or they may have sought care elsewhere. Advanced Access considers wait time from the patient perspective and, as a result, all waits are bad.
Have a piece of paper for each receptionist with each physician’s name. Start by having the receptionist or booking staff, each time an appointment is booked, place a hash mark on a piece of paper that corresponds with the requested provider’s name. Do this for each appointment that is booked. A hash mark should be placed by the primary care provider’s name regardless of whether the patient walks into the clinic, calls in, a fax referral is received or other. The important concept here is that the requested provider gets the hash mark. If an appointment is booked with another provider, in the case where the family physician is unavailable, the family physician still gets the hash mark for demand. This will provide information regarding the demand for each provider in your setting. Remember, the goal is to balance supply and demand.