1. Advanced Access & Office Efficiency Learning Session 2
PSP master PowerPoint template specifications
Font throughout: Myriad Pro
Title font colour: RGB
All text font colour: RGB
Title and ending slides:
Title: 44 font
Speaker: 32 font
Place and date: 20 font
Content slide (positions from top left corner):
Title: 32 font; title text box: horizontal 0.56” vertical 0.25”
Main text box: horizontal 0.56” vertical 0.25”
Footnote: 12 font; horizontal 0.56” vertical 7.25”
Font sizes and bullets: see slide 2
PSP logo: horizontal 9.23” vertical 7”; size = height 0.75”, width 1.74”
Page number: horizontal 10.39” vertical 7.67”
Position of graphics and text from top left corner:
Top graphic: horizontal -.01” vertical 0.12” (short orange and long taupe)
Bottom graphic: horizontal 0” vertical 8.08” (long taupe and short orange)
PSP logo: horizontal 1.06” vertical 1.17” ‘ size = h 1.29” w 3”
Master title: horizontal 0.56” vertical 3.5”
Speaker: horizontal 0.56” vertical 5.08”
Date and place: horizontal 0.56” vertical 5.92”
Information box: horizontal 1.64” vertical 3.17”
MOH / BCMA logos: horizontal 6.72” vertical 7.04”; size = h 0.71” w 2.5” – must be on title and ending slides
GPSC / SSC / Shared Care logos: horizontal 3.46” vertical 5.83”; size = h .66” w 4.82” – must be on last/ending slide
PSP website URL pspbc.ca: horizontal 1.06” vertical 7.17”; size = h .39” w 3” – must be on title and ending slides
Advanced Access & Office Efficiency Learning Session 2

2. Welcome back! Agenda Advanced access key concepts
Share progress & measures from action period #1
Revelations in some practices
Examine delays within the practice
Introduce and discuss ways to recapture lost capacity within your practice

3. Faculty/Presenter Disclosure
Speaker’s Name: Speaker’s Name
Relationships with commercial interests:
Grants/Research Support: PharmaCorp ABC
Speakers Bureau/Honoraria: XYZ Biopharmaceuticals Ltd
Consulting Fees: MedX Group Inc.
Other: Employee of XYZ Hospital Group
Presenters must disclose personal relationships with commercial interests (one slide per faculty member/presenter). Must be presented at all Mainpro+ certified events.

4. Disclosure of Commercial Support
This program has received financial support from [organization name] in the form
of [describe support here – e.g. educational grant].
This program has received in-kind support from [organization name] in the form
of [describe the support here – e.g. logistical support].
Potential for conflict(s) of interest:
[Speaker/Faculty name] has received [payment/funding, etc.] from
[organization supporting this program AND/OR organization whose product(s) are
being discussed in this program].
[Supporting organization name] [developed/licenses/distributes/benefits from
the sale of, etc.] a product that will be discussed in this program: [enter generic
and brand name here].
Presenters must outline connections/support for development/presentation of the program from commercial entities or organizations including educational grants, in-kind services (e.g., logistics) AND specific aspects of the faculty/presenter connections that a reasonable program participant might consider relevant to the presentation, (e.g., products made by companies named in Slide 1 that could be germane (relevant/pertinent?) to the presentation). Must be presented at all Mainpro+ certified events.

5. Mitigating Potential Bias
[Explain how potential sources of bias identified in slides 1 and 2 have been
mitigated].
Refer to “Quick Tips” document
Presenters must outline connections/support for development/presentation of the program from commercial entities or organizations including educational grants, in-kind services (e.g., logistics) AND specific aspects of the faculty/presenter connections that a reasonable program participant might consider relevant to the presentation, (e.g., products made by companies named in Slide 1 that could be germane to the presentation). Must be presented at all Mainpro+ certified events.

8. Collaborative Aim
The care of patients will be redesigned to improve access, capacity and efficiency.
How will the aim be accomplished? Advanced Access, and Office Efficiency change packages will be used to decrease the wait time of patients for, and at, appointments in Primary Care
How will we know this has been accomplished? Change will be evidenced by improved 3rd next available appointment, and improved appointment cycle time.

9. Review of Learning Session 1
Advanced access is “doing today’s work today”
Understand, measure and balance your supply and demand
Reduce your scheduling complexity
Work down your backlog
Develop contingency plans

10. Action period report-out
Tests of change
Successes
Challenges
Measurement
Supply

11. Introduction to Office Efficiency
“All systems are perfectly designed to get the results they get”
- W. Edwards Deming
“I had to think about this for awhile before I jumped in. I realized everything in medicine has changed steadily. We are constantly looking for better ways to diagnose and treat patients. But, office flow has stayed the same for 50 year. It is about time we pay attention to it.”
- Dr. Patrick Macken, Nephrologist

12. Aim
To reduce delays at an appointment

13. Benefits of Improved Office Efficiency
Appointments start and end on time
Work days start and end on time
Office visit is optimized; patient-provider time protected
Rework and duplication of work is decreased, thereby increasing capacity
Experience of patient, staff and provider is improved
Costs/visit are decreased
Income is increased

14. Measure of Office Efficiency
Cycle Time
From time of “check-in”, until time of “check-out”
Gain insight into possible bottlenecks in practice processes
Assess your practice, from patient’s perspective

15. Provider-Patient Interaction Completion of procedures/orders
Patient flow through the office
Patient enters
Wait
Registration
Pre-Red Zone
Wait
Exam Room
Cycle time
Wait
Provider-Patient Interaction
Red Zone
Wait
Completion of procedures/orders
Post-Red Zone
Wait
Checkout
Non-appointment time = 15

16. Provider-Patient Interaction Completion of procedures/orders
Patient flow through the office
Patient enters
Registration
Pre-Red Zone
Exam Room
Cycle time
Provider-Patient Interaction
Red Zone
Completion of procedures/orders
Post-Red Zone
Checkout
Non-appointment time = 16

17. Measuring cycle time

18. Key Concepts of Office Efficiency
Predict and anticipate care needs
Streamline work and standardize where possible
Optimize the care team

19. 1. Predict and Anticipate Needs
Know the work:
Knowing what you do (know your processes)
Knowing how it happens (flow mapping)
Knowing how often it happens (measures)

20. “Know Your Processes” Activity Each person completes the form
Discuss results with your team
Identify 1-3 areas for improvement
Identify potential strategies
Debrief as a large group
You have 20 minutes for this activity

21. Break

22. Process Mapping What is a “process”?
A series of connected steps or actions with an identifiable start and end point
Leads to a specific outcome
Why map a process?
It illustrates “how things work in our practice”
Includes several perspectives
Starting point for improvement

23. Process Mapping Oval - the start and end of the process
Box - the tasks or activities of the process
Diamond - a question is asked; a decision is required
Arrow - the direction or flow of the process

24. Example Steps: Patient enters room for appt. (start)
Provider enters room
Provider discusses Pt’s needs
Provider examines Patient
Provider IDs need for urine specimen
Patient given specimen cup
Provider completes paperwork
Follow-up instructions given to Patient
Patient leaves (end)

25. Patient enters room for appt Provider enters room
Provider discusses patient’s needs
Provider examines patient
Provider IDs need for urine specimen
Patient given specimen cup
Patient leaves
Provider completes paperwork
Follow-up instructions given to patient

26. Process Mapping Activity
Please pick one process in your office and map it
You have 20 minutes for this activity

27. Table Discussion Where are the hand-offs in the process?
Is it clear who does what?
Where are the delays?
Is there duplication or rework?
Are there identifiable areas where a small change could make an improvement?

28. 2. Optimize the Practice Care Team
Who does what?
Who could do what?
Who should do what?

29. Activity Review the measurement tools Review your schedule
Assess backlog

30. The Practice team … Is pro-active instead of reactive
Knows, trusts, supports and values each other
Communicates with each other, does not feel isolated
Is accountable to each other and to the patient
Uses measures for feedback and to guide improvement

31. Daily Huddles A brief (5-10 mins) meeting to: review schedule
deal with issues left over from previous day
anticipate needs for current day

32. Other Ideas, Strategies and/or Tools
Reason for visit card
Scripts – greeting, booking, reason for visit
Standardization – checklists, policies, exam room stocks
Interruptions log
Patient experience survey
Track start/end times

33. The Model For Improvement
What are we trying to accomplish?
How do we know change is an improvement?
What changes can we make that will result in an improvement?

34. change is an improvement?
What are we trying to
accomplish?
How will we know that a
change is an improvement?
What changes can we make that
will result in improvement?
Model for Improvement
Act
Plan
Study Do

35. Where do I start? What are you going to do next Tuesday?
What is your aim?
Determine how you will measure/track improvement

36. Action Period #2 Implement small tests of change Measure and track
RST support
Continue to work toward your access aim

37. Good Luck!