OPEN ACCESS AND REDESIGN Kate Kubler (MSII) and Chris Soares (DSII)
An opportunity for Improvement: No show rates for providers on average are 25% CHCs are offsetting high no show rates by double booking appointments, creating a burden on the care team 3 rd available appointment (a measure to show a provider s accessibility) has been over a week in many CHCs that have tracked availability Acute care patients are unable to see their provider due to backlog. This causes patients to either wait for days or end up in the ER
What is Access? The patient gets an appointment for care with his provider when he wants it. What is Redesign? Patient s visits are efficient; there are no wait times during a visit Collectively, open access and redesign are concepts that try to balance a provider s supply of appointments with the demand of the provider s patient panel. Making visits more efficient can save time and effort for both the patient and provider, which is why many CHC are starting to look into this model
Dr. Mark Murray, often known as the father of open access and redesign, in a 2007 Businessweek article: During the 1990s, Murray tried everything from increasing overtime to centralizing the phone system, but nothing seemed to have any effect on the bottlenecks. He was responsible for 250,000 patients, 100-plus doctors, and 400 support staff, and nobody was happy. That's when he realized that his problem was one the business world had solved long ago. "If you go to Starbucks, they don't ever say, 'we don't have lattes today, come back later,'" he says. "They have a plan to match their supply with your demand as quickly as possible. Why can't [health care] be the same way? Businessweek 2007
So Where Do We Start?
The Nine Steps to Successfully Implementing Access and Redesign 1. You introduce A/R Be the agent of change for your CHC 2. Leadership Buy In They represent the key to success 3. Form A/R Team Team must represent all disciplines of your CHC 4. Data Collection Use measures that will help your CHC specifically 5. Needs Assessment Identify significant opportunities for change at your CHC 6. Identify Goals Create S.M.A.R.T. goals 7. PDSAs Testing new ideas and improvements in brief cycles 8. Patient Education Patient understanding is essential for system to be beneficial 9. Regular Team Meetings Continuous improvement means active team participation
Step 1: You Introduce Access and Redesign (A/R) You realize that your CHC could benefit and become more efficient through this model Using previous work of other practices and CHCs, become familiar with how others have successfully implemented A/R Realize that you are the CATALYST in this process, and you must act as an agent of change in order to help form this initiative As an agent of change, you identify and educate members of your CHC interested in making the A/R leap
Step 2: Leadership Buy In This is the most essential step for successfully implementing A/R Successful leadership buy in means that executive leaders: Comprehend that long-term benefits outweigh preliminary set-backs Actively participate in the evolution of the process and interact with all members of the team Engage in regular face time, and are willing to be present, giving verbal and non-verbal support throughout A/R Executive buy in reinforces the efforts of all other team members (providers, nurses, MA, office staff) and encourages commitment and endurance of the team as a whole
Step 3: Forming an A/R Team An effective A/R team requires representatives from all disciplines at your CHC Identify team leads (providers, PA, APRN) responsible for assembling a collaborative group that shares a common vision for the CHC The AR team collectively accepts responsibility for all data collection necessary to making a needs and goals assessment specific to the CHC Usually, a team should have members representing: Providers and Pas APRNs and nursing staff Medical Assistant Office Staff Executive involvement
o Compile tools for collecting data Step 4: Data Collection o Depending on team s goals they may use some or all of the following measures to help measure how effective, accessible, and efficient your CHC is performing o Panel size of patients per provider o Continuity of Care Measures o Third next available appointment o Supply and Demand of Appointment o No Show Rates o Backlog o Cycle Time o Wait Time
Step 5: Needs Assessment Use the collected data from your team s chosen measures to identify strong and weak aspects of your CHC Rate by importance, problematic areas that are in need of quality improvement Define the goals for A/R of your CHC using results of your needs assessment and data collection Discussion of needs assessment findings between executives and the A/R team facilitates creation of goals that appease both parties
Step 6: Identify Goals Create goals based upon data collection and needs assessment Tackle your goals as you would a puzzle: Keep big picture in mind but start implementing change piece by piece Make S.M.A.R.T goals that are attainable S.M.A.R.T. goals are: S: specific, significant, stretching M: measurable, meaningful, motivational A: attainable, agreed upon, acceptable, achievable R: relevant, reasonable, realistic, rewarding T: time-based, tangible, track able
Step 7: PDSAs PDSA stands for: P: Plan- innovative idea to help make CHC more efficient D: Do- test idea out in the practice S: Study- like data collection see if idea was more efficient A: Act - Make it part of daily use The PDSA cycle is a trial-and-learning method to test changes quickly to see how they work. Teams repeat these test cycles until change is ready for broader implementation (reference health disp. Collaborative)
Step 8: Patient Education A/R is only successful, if patients understand how to use the new system Need to have education for patients in different learning modes (written in a reminder card; spoken when the provider or another member of the team explains the new system; visual when there is a cartoon detailing the new procedure for call centers, etc. Identify potential communication barriers specific to your patient population. (example- bilingual appointment cards and color coding of care teams) See resources for suggestions on how to educate different populations
Step 9: Regular Team Meetings Creates accountability and a system of trust, support and knowledge Reinforces overall timeline and deadlines for A/R Keeps communication open for all members of the team A/R plan can always be improved WARNING: absence of regular follow up meetings can be hazardous to A/R team health and progress (old habits may come back )
For more information, please contact: Scott Selig, MAT Director of Clinical Quality Email: sselig@chcact.org Phone: (860) 667-7832