Timely and Productive Appointments: Are you Primed?

The 26 th Annual IHI National Forum on Quality Improvement in Health Care December 7-10, 2014 Orlando Florida Timely and Productive Appointments: Are you Primed? Session D24/E24 HANDOUTS Mina Viscardi Johnson Quality Improvement Specialist mina.viscardi-johnson@hqontario.ca Health Quality Ontario 130 Bloor Street West, 10 th floor Toronto, ON, M5S 1N5, Canada www.hqontario.ca Susan Taylor Manager, Clinical Adoption susan.taylor@hqontario.ca Health Quality Ontario 130 Bloor Street West, 10 th floor Toronto, ON, M5S 1N5, Canada www.hqontario.ca

Principles of Advanced Access and Efficiency in Primary Care Access: Doing today s work today and giving the patient an appointment when they want or need one. 1. Understand and Balance Supply and Demand the gap between current performance and possibility need to build capacity to meet patient demand with good flow 2. Increase Supply of Visits must identify and manage the constraints who is doing the work who should be doing the work must optimize the care team 3. Reduce Demand for Visits need to reduce no-shows, max pack the visits and challenge and extend the revisit rate as well as explore alternate care delivery models 4. Reduce Appointment Times and Types this principle will reduce the number of queues as a wait time is associated with each different appointment type reduce the appointment types and decrease the delay 5. Reduce Backlog add temporary supply in order to reduce the bad backlog (appointments not driven by physiology) must increasingly do more of today s work today. 6. Develop Contingency Plans address daily and seasonal variation in supply and demand to maintain the goal. Fluctuation/variations are expected but must be continuously monitored and addressed to maintain an open access environment Efficiency: The processes in an organization to make the best use of resources add value for the patient or client and eliminate waste or delays. 1. Balance supply and demand for non-appointment work understand and balance the non -face to face demands on a practice such as documentation, medication refills, lab reviews, etc. 2. Synchronize patient, provider, information, rooms, equipment through process mapping all activities must be identified, the value stream must be maximized i.e. Start on time and stay on time. 3. Predict and anticipate patients needs be prepared for the patient visit through the use of huddles (brief team meetings), good communication and signals between the whole team 4. Optimize rooms, staff and equipment through standardized layouts of the rooms and supplies as well as staff who are optimally trained and cross trained all resources can be used to their full potential 5. Manage constraints identify the person or process that is in front of the situation where the most waiting occurs through process mapping; move work away from the constraint. Maximizing the care team to full scope of practice will also help to manage constrictions. 6. Eliminate Waste identify any limiting steps within your processes The Goal is to have both Access to the appointments and Efficiency at the appointments 2

Panel Size Equation Form Your turn: X = #weeks worked annually # units/week Annual Supply X = # patients visits per patient per year* Annual Demand *To calculate visits per patient per year, use one of the following methods: 1) Divide the number of unique patients seen in the last 12 months into the number of visits to the practice that these patients generated within the same period. 2) Use 3.19 as a proxy until you are able to calculate your own 1 1 The proxy of 3.19 comes from 5 years of data through Mark Murray s work with Kaiser primary care practices in the US. 3

Tracking Daily Demand, Supply, Activity and No Shows by the Provider Instructions: Supply: At the beginning or end of each day, use the appointment schedule to gather the supply information. Record the number of appointments (using the shortest appointment slot) for each day. This includes all appointments in the schedule, whether they are booked or not. Demand: Every day, record the number of requests for an appointment with the provider. Record every request, whether or not the appointment is booked for that day or a future date. This includes follow-up appointments people make as they leave your office (internal demand), as well as the external demand that comes through by phone, walk-ins, fax or email. Tip: Use the shortest appointment slot as your basic unit of measurement, and tick off every unit of appointment. For example, if your shortest appointment slot is 10 minutes, use this as your basic unit of measurement; e.g., a 30-minute appointment would be recorded as three ticks. Demand Count: Place a tick beside each request for a short appointment. Remember that long appointments need more ticks. No shows (FTKA): At the end of the day, count the number of booked appointments that were not used and for which the patient did not call to cancel. Activity: At the end of the day, use the schedule to identify the actual number of short appointment slots used that day. If the provider had add-ons, then the number will be higher than the supply. If the provider had no shows or vacancies, then the number will be lower than the supply. DAY: INTERNAL DEMAND EXTERNAL DEMAND DEMAND TOTAL SUPPLY TOTAL ACTIVITY TOTAL NO SHOWS Monday Tuesday Wednesday Thursday Friday 4

A Schedule to Test Monday Tuesday Wednesday Thursday Friday Supply (number of smallest unit of appointments) Supply (number of smallest unit of appointments) Supply (number of smallest unit of appointments) Supply (number of smallest unit of appointments) Supply (number of smallest unit of appointments) Pre-booked* (e.g., Chronic Disease, F/U s, Well Baby, etc.) Pre-booked* (e.g., Chronic Disease, F/U s, Well Baby, etc.) Pre-booked* (e.g., Chronic Disease, F/U s, Well Baby, etc.) Pre-booked* (e.g., Chronic Disease, F/U s, Well Baby, etc.) Pre-booked* (e.g., Chronic Disease, F/U s, Well Baby, etc.) Open* (e.g., Acute Episodics, URTI s, UTI s, Flu, etc.) Open* (e.g., Acute Episodics, URTI s, UTI s, Flu, etc.) Open* (e.g., Acute Episodics, URTI s, UTI s, Flu, etc.) Open* (e.g., Acute Episodics, URTI s, UTI s, Flu, etc.) Open* (e.g., Acute Episodics, URTI s, UTI s, Flu, etc.) Comments: Comments: Comments: Comments: Comments: *Pre Booked and Open slots can be spread throughout the day in order to meet patient need. Remember, book early/book late for follow-ups Combine multiples of the basic short appointment for longer appointments to address complex visits 5

Front Desk Strategies to Support Advanced Access and Efficiency in Primary Care Front desk staff has a crucial role to play in a successful Advanced Access environment and using the following strategies will help. Strategy Tips Offer Appointment on Day of Choice: Patients should be able to book an appointment for today, or the day of their choice, at the time that they call When we ask people to phone back, we create a process called Access by Denial. This deflects demand and creates additional waits and delay in the system Strategic Scheduling Offer same day appointments Schedule pre-booked appointments later in the week and earlier in the day - determined by supply/demand (book early, book late) Guide patient to open slots you want to fill first Managing vs. Guarding Do today s work today. Protecting appointments creates backlog Route patients to the appropriate provider Try looking at weekly schedule vs. daily schedule Know your patients Truth in Scheduling Data collection is key to understanding the demand and supply of the practice Know your capacity and organize your supply to meet your demand Reduce appointment types to reduced queues Do not ask patients to call back for an appointment, or limit their ability to pre-book an appointment. Move away from a system where patients need to plead their case to be seen. Aim to offer an appointment for today with the patient s provider, regardless of the reason for the visit. The first question the scheduler asks is not what is your medical problem? But who is your primary care provider? Use a reminder system to prompt appointment scheduling closer to the time of the appointment for patients who require an appointment that is longer than three to four months out, for physiological or other reasons. Track demand data to understand the pattern of appointment requests (daily and weekly demand) and where to guide pre-booked appointments. Schedule pre-booked appointment first thing in the morning. Fill morning appointments before offering afternoon appointments. If late in the afternoon and same day appointments are filled, it is an option to offer an appointment tomorrow. Do not tell the patient to call back (access by denial). Do not hold appointments because you feel something more urgent will come up. Knowing your daily demand will assist in these circumstances. Is it necessary for the patient to see the physician or is it appropriate that they be seen by someone else on the care team? Review the weekly schedule to give you a view of what is to come. Is there anything you can move forward (e.g.: for a cancelled physical you can have the option to use for a same day appointment or bring another appointment forward). e.g.: When a patient who routinely brings family members along calls for an appointment, ask them if they require more than 1 appointment. Know your daily demand Know what constitutes a long and short appointment Communicate with provider regarding their schedule (e.g. if provider is going to arrive at 9:30, then appointments need to begin at 9:30 not 9:00) Have you allowed sufficient time for the reason for the appointment? Once the patient has been offered an appointment, ask patient the reason for their appointment so you can schedule appropriately Can you max-pack the appointment? (use health prompts/alerts) 6

Communication Strategies Patients may be surprised and unprepared for a same day appointment when you first get started. Scripting is not used for triage, but rather for routing patients to alternate providers wherever possible. Reduce No Shows When a patient does not show for an appointment or arrives late, the result is lost provider supply Manage Late Arrivals Be prepared for late arrivals and how to manage them. Remember that providers often keep their patients waiting. Be Prepared- Planned Prepared Visit Staff at the front desk have a key role to play in contributing to a planned, prepared practice team responding to the needs of the patient at the appointment. Commit to measuring your demand (daily/weekly/panel size) at regular intervals. Things change over time and this may be an indication to update your scheduling processes. Use scripting to help schedulers talk with patient about advanced access scheduling. Messages need to be simple and clear. e.g.: Dr. Quality can see you today (tomorrow) at 10:30 or 1:15. Do either of these times work for you? e.g.: Dr. Quality is out of the office and will be returning in four days. I can make an appointment for you when the doctor returns. Reduce backlog in the system to avoid booking appointments too far into the future Prompt the patient to call you if unable to keep the appointment. Your appointment with Dr. X is on Monday June 20 th at 1:00pm. You will give us a call if you are unable to keep that appointment won t you? Identify the patients who frequently do not show for their appointments and develop strategies to increase likelihood that they will keep their appointment. Use a signal to let the provider know that a patient is late and have high priority work available for them to do while waiting. When possible work the late patient into the schedule to avoid deflecting demand to the future. Identify patient needs when booking the appointment and use the daily huddle to prepare the team for the day. Identify opportunities for front desk staff to respond to EMR alerts for preventive screening. Resources: HQO Script for Appointing Patients; HQO Advanced Access and Efficiency Workbook; Murray, M. (2005) Answers to your questions about sameday scheduling. Family Practice Management. Pg 59-64; HQO Predict the Expected Contingency plans to manage advanced access scheduling. 7

Summary of Advanced Access and Efficiency Measures For more information, please see our AA/E workbook at advancedaccess.machealth.ca Measure WHAT IS IT AND WHY DO IT? HOW TO GATHER FREQUENCY OF COLLECTION TIPS Panel size equation To understand the relationship between supply and demand within your practice, and to be able to develop strategies to balance if necessary. Use the panel size equation Annually, or as changes in supply or demand occur. If demand is greater than supply, remember that this is a yearly number. It must be divided by 12 to understand the number of appointments required monthly, and then by four to see the number of extra appointments needed each week, etc. Third next available (TNA, 3NA) Supply This is the gold standard for measuring the length of time patients in your practice are waiting for an appointment. First and second available appointments are not used, as they could be the result of a recent cancellation. The number of appointments available in the schedule. All appointments should be multiples of the short appointment length. At the same time on the first day of the work week, look ahead in the schedule for the TNA appointment slot and then count the number of days to that appointment. Do not count saved appointments or carve out model appointments Count the number of available appointments for each work day. Weekly until the value is consistently zero. Then use future open capacity to measure availability of appointments You should understand supply on a daily, weekly and annual basis. Once established it does not have to be counted unless supply changes. It is important to use a consistent method of data collection. Counting weekends is a choice (either do or don t) but the same method of data collection must be used consistently If provider supply increases or decreases permanently, then the equation must be recalculated. Demand The number of appointments requested today for any day. Demand can be generated internally by the provider and externally by the patient. It is important to understand both internal and external demand, and to measure each separately Using a tick sheet (see Section 5.1), place a tick mark for every appointment requested, depending on the origin. External demand is patient request and internal demand is provider request Daily until practice confidently knows range of demand for each working day. It is important to gather this data anytime practice demand seems to be changing. It may be necessary to rebalance supply and demand 8

Measure WHAT IS IT AND WHY DO IT? HOW TO GATHER FREQUENCY OF COLLECTION TIPS Activity The actual number of short appointment slots used that day. If the provider had add-ons, then the number will be higher than supply. If the provider had no shows or vacancies, then the number will be lower than supply. From the EMR/EHR or schedule book, count the number of short appointment used each working day. Daily until practice confidently knows the range of activity for each working day. Daily until practice confidently knows the range of activity for each working day. No shows or failure to keep appointment (FTKA) Backlog Cycle time Red zone (valueadded time) Patients who do not keep appointments and do not notify the practice prior to their scheduled time. These appointments represent lost productivity and resources. The number of appointments between the present and the TNA appointment. Do not count appointments that are booked due to patient choice or physiology. The time elapsed between the scheduled appointment time and the time the patient is walking out the door. This information will help the practice understand the patient flow and where waiting occurs. It will also identify opportunities to improve efficiency or reduce the number of steps in the process. Percentage of the cycle time spent in face-to-face contact with a member(s) of the care team. Keep track of the number of patients who fail to keep their appointments and record on the Demand, Supply, Activity and No Shows worksheets. Count the number of appointments between now and TNA. A cycle time tracking sheet is necessary. Patients can be asked to track the times at various steps within their appointment. Other methods to collect this information may work better for your practice. This information is used in conjunction with the process map. On the cycle time form calculate all the minutes spent with members of the care team. Divide by the total number of minutes spent at the appointment and multiply by 100 to get the percentage of face-toface time. Daily. Anytime the TNA is increasing above acceptable practice targets. As often as is required to understand the length of patient visits in order to inform tests of change. Repeat each changes are tested or implemented. As often as is required to understand the length of patient visits in order to inform tests of change. Repeat each time changes are tested or implemented. When patients notify the practice of their inability to attend, their appointment is a cancellation and not a no show. Be sure the practice can distinguish between good backlog and bad backlog Decide as a team the number of random samples required to inform the quality improvement team. Sample at different times of the day or days of week. Include time the patient spends with all members of the care team that adds value to their visit. 9

Advanced Access and Efficiency for Primary Care Change Package How to Use the Change Package This package describes the change concepts, or ideas for innovation, that have been shown to improve access and efficiency in primary care practices. A change concept represents a set of practices, ideas and tools that have shown demonstrated effectiveness in other environments and can be tested to ascertain their impact in your environment. Change concepts are broad changes or general approaches that have been found useful in making an improvement. These concepts are not specific enough to be applied directly, and not all concepts will be of interest or appropriate for you at this time. Rather, this package is a menu of possible concepts to consider as you set out on your improvement journey. After you choose concepts to work on, you will need to tailor the ideas to your situation, and describe them in enough detail so that they can be tested using quality improvement methodology. After testing, if your data show that the change is making an improvement in your setting, you can make plans to implement the changes, to ensure the improvement sticks. 2 Change Concepts for Improvements to Advanced Access 3,4 Advanced Access Change Concepts Understand and balance supply and demand Understanding the patterns of both demand and supply on a weekly, monthly or seasonal basis lets you focus your efforts on shaping demand to match supply, and/or increasing (or decreasing) supply during periods of high (or low) demand. The foundation of improved access scheduling is matching the supply and demand on a daily, weekly and long-term basis. Increase the supply of visits Increasing the supply of visits helps to balance patient demand, and can be accomplished in ways other than providers working more hours. Change Ideas Use the panel size equation to determine the annual supply and demand for each provider. Measure demand for all appointments by provider and day. Measure supply of appointments by provider and day. Measure the activity (number of appointments used) by provider and day. Develop a plan for redistributing workload as needed. Develop a plan to monitor provider patient loads monthly. Identify the number of providers and appointments needed to meet daily demand. Adjust provider/staffing hours to match demand pattern. Manage variation in demand (e.g., guide pre-booked appointments to days when you tend to have more supply than demand). Make sure to do today s work today after eliminating backlog. Develop a plan to continuously measure supply and demand for appointments. Use regular huddles and staff meetings to organize the day and to optimize team communication. Maximize provider and staff schedules. Optimize the care team ensure all team members are functioning to their highest level of certification/licensure to maximize response to patient needs. Remove unnecessary appointment work from providers. Make sure providers have time to do provider work that only they can do. Look for appointments that could be managed by non-providers. Identify and manage the constraint. Use guidelines and protocols for treatment of simple, common conditions. Group visits and/or shared medical appointments. 2 Langley, G.J., Moen, R.D., Nolan, K.M., Nolan, T.W., Norman, C.L., and Provost, L.P. (2009). The Improvement Guide. 2nd Ed. Jossey-Bass: San Francisco. 3 Ontario Health Quality Council (March 2009). Quality Improvement Guide Module 1: Access. Toronto. Available at: http://www.hqontario.ca/en/qi_teams.php. 4 Institute for Healthcare Improvement. Improving Primary Care Access. Available at: http://www.ihi.org/knowledge/pages/changes/measureandunderstandsupplyanddemand.aspx. 10

Advanced Access Change Concepts Reduce demand for visits Reducing the level of demand makes it easier for the system to absorb current and future levels of demand. Reduce appointment types and times Complex schedules with many appointment types, times and restrictions can actually increase the total delay in the system, because each appointment type and time creates its own differential delay and queue. Reducing the complexity ultimately decreases system delays. Reduce backlog Backlog consists of appointments in the future schedule that have been put off because of lack of space in the schedule to do the work sooner; working down the backlog recalibrates the system to improve access. Develop contingency plans The natural variation in supply and demand that occurs as part of the everyday functioning of a practice often creates problems that contingency plans can address. Change Ideas Use technology, including EHRs/EMRs, e-mail, telephone and patient portals. Encourage patient engagement and self-management. Max-pack and reset the schedule. Challenge/extend return-appointment intervals. Promote continuity (match patient with his/her provider for each visit). Develop a plan to reduce no-shows. Develop alternatives to face-to-face interactions group visits, e-mails, telephone and care management. Promote patient self-management. Review future schedules to ascertain if patients could be managed differently. Make the visit more effective by utilizing other team members. Maximize the efficiency of each visit. Standardize appointment types and lengths. Reduce and use only a small number of types and lengths of appointments. Identify appointment types with specific needs, such as specific staff or rooms, or that need more time. Create a plan to merge/accommodate appointments that will take longer. Educate staff on booking to the provider, not to the first open space on the schedule. Adjust the schedule to match the reality of the provider s pace (truth in scheduling). Measure backlog. Distinguish between good and bad backlog. Develop a plan to reduce the bad backlog (e.g., add additional appointments temporarily). Develop a communication plan. Set beginning and end dates. Plan for staffing support. Develop plans for any additional needs while reducing backlog. Display wait time data. Protect providers with short wait times don t fill their schedules up with others work. Review supply and demand patterns to determine the causes of variation. Develop proactive contingency plans to cover demand variances, such as vacations, immunization seasons, school physicals, hospital admissions, clinic visits that take longer than expected, etc. Develop a plan to cover the extra work of providers due to both expected and unexpected reasons. Set follow-up appointments towards the end of the week, and early in the day. Develop time-off policies. Smooth appointment flow. Review bookable hours. Identify an end-of-day cut-off time (which is not based on full ). Develop plans for working with mid-level providers. Develop scripts for common occurrences late patients, appointment scheduling, patients without a primary care provider, etc. Use appointment reminders. 11

Change Concepts for Improvements to Office Efficiency 5,6 Efficiency Change Concepts Balance supply and demand of non-appointment work Understanding the patterns of demand and supply at the appointment level will allow you to focus efforts on reshaping and rebalancing this system to match the work. Synchronize patient, provider, information, room and equipment Analyzing and addressing the factors that contribute to delays at an appointment will allow for the planning and testing of improvements. Anticipate and predict patient needs Communication is critical to allowing the team to operate effectively in anticipating and addressing patient/client needs. Optimize rooms, staff and equipment Set the team up for success by managing the environment to promote optimal team performance. Change Ideas Process-map the patient/client journey across the office. Do a clinic walk-around with observations. Measure cycle/lead times. Begin a care-team workload analysis. Study and predict daily demand for non-appointment work. Match the demand to the correct resource. Study and understand your support staff supply. Separate responsibilities for phone, patient flow and paper flow. Map out specific support processes and improve them (e.g., processes for messages and communication, prescription refills, form completion). Develop a philosophy of doing this moment s work this moment. Start morning, afternoon and evening sessions on time. Develop a script for patient/client arrival and scheduled-with-provider times. Register patients/clients by telephone. Do an interruption study and limit interruptions, especially for providers. Use health prompts to anticipate full potential of today s need. Use a chart check to ensure that all information is correct. Develop mechanisms to keep rooms open. Do a minutes-behind graph. Institute a 15-second rule for asking providers a question between appointments. Use scheduled pauses to apply continuous flow approach to non-appointment activities (e.g., return phone calls). Use huddles to communicate across providers and staff throughout the day. Plan and prepare for the patient visit. Obtain and organize all information, equipment and supplies before the patientprovider interaction (e.g., test results in the patient chart, supplies for physicals in the exam room). Create a reminder system for planned care. Develop a plan for late patients/clients. Develop a plan for late providers. Plan for procedures and other unusual appointments. Plan for expected and unexpected interruptions in flow. Do as much as possible with standard protocol. Develop a plan for scheduled team meetings both monthly and weekly. Communicate among the care delivery team throughout the day using huddles, technology, etc. Use open rooming to maximize flexibility. Standardize rooms. Standardize equipment and supplies. Keep rooms fully stocked at all times (e.g., insert a reminder form near the back of the pile of forms so that the clerk sees that the form has been taken out and knows to restock). Use standard layouts/supplies. Develop signals for equipment. 5 Ontario Health Quality Council (March 2009). Quality Improvement Guide Module 2: Efficiency. Toronto. Available at: http://www.hqontario.ca/en/qi_teams.php. 6 Institute for Healthcare Improvement. Improving Primary Care Access. Available at: http://www.ihi.org/knowledge/pages/changes/measureandunderstandsupplyanddemand.aspx. 12

Efficiency Change Concepts Manage constraints We can only go as fast as the slowest step, and we want that slowest step to be the natural pace of the provider/patient interaction. If the constraint is elsewhere, it is reducing efficiency. Eliminate waste Identify steps and activities that do not provide value and seek efficiency to reduce or eliminate them. Change Ideas For limited equipment, develop plans to know the location of equipment at all times. Complete a care-team workload analysis. Co-locate staff and equipment if possible. Cross-train staff. Identify the constraint (person or process). Drive unnecessary work away from the constraint. Define all roles and responsibilities. Re-allocate work to the appropriate level of skill, expertise and licensure. Reassess forms for ease of completion (check-off boxes, etc.). Process-map all provider support processes and look for leverage opportunities. Use automation and technology. Move steps in the system closer together. Use continuous flow to avoid batching. From process maps, seek to identify and eliminate non-value steps. Use the eight forms of waste to trigger ideas for testing changes (overproduction, waiting, transportation, over-processing, inventory, motion, defects and human potential). Use LEAN fundamentals to focus on patient/client needs and have the flow driven by patient/client, not by the provider s perspective. 13

Advanced Access & Efficiency in Primary Care As part of its work to foster quality improvement capacity in Ontario s health system, Health Quality Ontario (HQO) offers Advanced Access & Efficiency support to all primary care practices and providers (i.e., physicians and nurse practitioners). The core principle of this initiative is that patients calling to schedule a visit are offered an appointment with their primary care provider on the same day, or on a day of their choice. By following Advanced Access & Efficiency principles and philosophies, primary care teams learn how to implement change concepts and evidence-informed care that will enable them to improve the patient experience for Ontarians. In addition to reducing wait times for patients, the benefits of learning and successfully implementing the principles of Advanced Access & Efficiency include: Improved office efficiency and patient flow Improved patient, provider and staff experiences Improved organization of care processes and continuity of care Improved provider access contributing to organizational targets in annual Quality Improvement Plans (QIPs) Improved provider access that contributes to achievement of Health Link performance targets Advanced Access & Efficiency This elearning stream will provide providers and primary care teams the ability to learn and implement the principles of Advanced Access & Efficiency. This platform will guide you and your team through 7 (25 minute each) elearning modules that will teach the principles of Advanced Access and Efficiency, provide tools and resources to understand your practice, and guide you through your improvement journey on achieving improved access within your practice. Includes: A comprehensive curriculum of seven MainPro accredited e-learning Modules (machealth) A suite of quality improvement tools and resources Membership in a community of practice focused on improving access to primary care Opportunity to register for the AAE Newsletter Opportunity to register for a measures portal to enable you and your team to enter and evaluate your data Module 1: What is advanced Access: Overview primer Module 2: What are we trying to accomplish? Learn the principles of Advanced Access and Efficiency Module 3: Is Your Practice Ready? Learn how to access your readiness and capacity to implement Advanced Access. This will help you determine what roles and tasks need to be addressed. Module 4: The Model for Improvement: Learn the Model for Improvement and Plan Do Study Act (PDSA) cycle and learn to apply them throughout your quality improvement work. Module 5: Assess Your Practice: Conduct an assessment of your practice and collecting data. Learn where to identify your starting place, areas for improvements and begin to make changes resulting in efficiency and sustainable improvements. Module 6: Designing and Testing Solutions: Use the work completed in previous modules to build your improvement plan. Module 7: Testing Change, Sustaining Gains: Use the PDSA cycle to test change ideas before adopting them into your practice. Start Now: Visit advancedaccess.machealth.ca to register For Assistance: please contact learningcommunityinfo@hqontario.ca 14

Chronic Disease Prevention and Management in Primary Care The Chronic Disease Prevention and Management course addresses the foundational concepts related to meeting the health management needs of those with Chronic Disease. Chronic Disease Management is complex and difficult for the person with chronic conditions, their family members, and health care providers. As part of its work to foster quality improvement capacity in Ontario s health system, Health Quality Ontario has developed resources to support Primary Care practices make improvements in their own practices to support clients with chronic disease. The program consists of five elearning modules; which will walk you through a process to make improvements in your practice. Chronic Disease Prevention and Management in Primary Care This elearning stream will provide providers and primary care teams the ability to learn test, and implement best practices, change concepts and innovative approaches to make improvements in Chronic Disease Prevention and Management in your practice. Includes : A comprehensive curriculum of five MainPro accredited e-learning Modules (machealth) A suite of quality improvement tools and resources Membership in a community of practice focused on improving access to primary care Module 1 - Preventing & Managing Chronic Disease: Ontario s Framework: Demonstrates how to use Ontario s Chronic Disease Prevention and Management Framework to assess and improve chronic disease management in your practice. Module 2 - Getting Started: Describes the essential features of a quality improvement team and illustrate how the model for improvement can be used to help teams set aims and achieve their goals. This module will also address how tests of change can lead to improvement. Module 3 - Defining Your Problem & Understanding Your System: Focus on finding areas of focus using Ontario s Chronic Disease Prevention and Management Framework. Participants will learn to use the Assessment of Chronic Illness Care (ACIC) to evaluate their practices and learn change ideas that will help them develop an effective improvement plan. Module 4 - Designing & Testing Solutions: Will introduce the tree diagram tool and discuss how it can be employed in the development of an effective improvement plan. Tree diagrams may be used to keep improvement teams focused on their shared goals and to determine if change ideas have had the desired impact. This module will also provide examples of how teams used change concepts to assist in tree diagram development, and used measures to determine if improvements were being maintained. Module 5 - Implementing & Sustaining Changes / Spreading Change: Describes the key elements of implementation, sustainability and spread. It will also provide examples of how to sustain the improvements that have been made and spread these improvements to other areas. Start Now: Visit cdm.machealth.ca to register Need assistance: Contact learningcommunityinfo@hqontario.ca 15