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Advanced Access Basics;Demand and Supply Calculations
Catherine TantauTantau & Associates
PO Box 179Chicago Park, California, 95712
530-273-6550ct@tantauassociates.com
www.tantauassociates.com©Tantau & Associates
2
Advanced AccessQuick Review….
AA is… No delays for an
appointment. CONTINUITY for
patients and providers.
Doing today’s work today
AA is Not… Holding appts in
anticipation of same day urgent demand.
A Walk in Clinic or Urgent Care Clinic.
Telling pts to call back when appts are released.
3
Start with an AimThe Gold Standard
Primary Care:
Offer an appointment today
for any problem (urgent or routine)
with the PCP or teammate in the absence of the
PCP.
4
Delayed systems…
Tension; medical definition, patient definition
Waste inherent in tending the delays “If you’re sick and you can prove it.” Pts get in anyway! Delays increase workload.
© Tantau & Associates
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The longer patients wait,The harder we work….
New PatientCalls
(1/wk/MD)
EstablishedPatient Calls
Switchboard
PCP Receptionist(4) #
(Most)
Admin.- Q & A- Page Pedi MA- Assist patient
Hold
Busy N.A.
Answer
Bounce to others whenPCP recept. fall
recept
Appt. req.
Q & ASick?
Not sure
Mesg. To MD
MD calls patient
Q & A
Advise Appt. Emerg. - ED
- Book it w/PCP- Overflow MD if walk in when avail
+
Next avail. w/PCP
-
Book it+ -
- Add on sooner- Occas. Msg to MD
Check insur. &confirm on 2systems new
patients longer
min. --hoursor lost
30" -hrs.
Note:- No triage on phone- Occas. triage walk in
Note:Always see pts.
Admin. to resolve- non PCP - 1st available
or
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RN Survey“In this office I have the opportunity to do what I
do best everyday.”
0
1
2
3
4
5
StronglyDisagree
Disagree Agree StronglyAgree
Source; CHC, Pacific Northwest, 2008
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What is Advanced Access ?
NO delays for an appointment. CONTINUITY for patients and
providers. Doing today’s work today…
So how many appts do weneed today?
What would Starbuck’s ask???
How many customers / day? What days are busiest? How many lattes? Vs Chai tea vs…??? How many pounds of beans do we
need? How much staff do we need to meet
daily and hourly variations in demand? What else????
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Demand
Illness Burden of Population
Mood and Attitude
Continuity
Measures: True demand
Measures: Panel Size (driver for
demand)
© Tantau & Associates
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Demand
Look at historical data? True Demand Formula:
External Appointment requests, called in and appted regardless of day
appted. To (today or future)
+ Walk-ins for appts.
+ Other portals of entry ?(email, fax,”add-ons” etc.) + Deflections (UCC etc)Internal
+ Returns booked today for the future
© Tantau & AssociatesTotal Demand
Appointment Demand Worksheet
Date: ____________
Care Unit 3
Patients calling today, requesting appt, regardless of day appted to
(External)
Walk-Ins today
appted
(External)
Deflections,
eg UCC, if trackable
(External)
Return appts booked today as pts leave today’s appt.
(Internal)
Total Demand
Optional; Pts
turned away, not booked. Do not
add into Demand
Provider
A
Provider
B
Provider
C
Provider
D
Total
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Measured demand
Calls for visits
Other external demand
Internal demand
# appt per day
Monday 44 2 29 75Tuesday 34 5 25 64Wednesday 29 8 35 72Thursday 30 3 18 51Friday 37 1 31 69
Provider capacity
# appt per day
Monday 70.125Tuesday 61.5Wednesday 87Thursday 58.875Friday 84
VISIT RATEVisits per hour
Provider A 3Provider B 3Provider C 2.25Provider D 3Provider E 3Provider F 3
HOURS per session Mon AM Mon PM Total Tues AM Tues PM Total Wed AM Wed PM Total Thu AM Thu PM Total Fri AMProvider A 3.5 4 22.5 4 12 3.5 2 16.5 4 12 3.5Provider B 0 2.5 3 16.5 2.5 3 16.5 0 2.5Provider C 2.5 4 14.625 0 4 9 3.5 4 16.875
Appointment Capacity versus Demand
0
10
20
30
40
50
60
70
80
90
100
Monday Tuesday Wednesday Thursday Friday
Provider capacity Measured demand
Measured demand
Calls for visits
Other external demand
Internal demand
# appt per day
Monday 0Tuesday 0Wednesday 0Thursday 0Friday 0
Provider capacity
# appt per day
Monday 0Tuesday 0Wednesday 0Thursday 0Friday 0
VISIT RATEVisits per hour
Provider AProvider BProvider CProvider DProvider EProvider F
HOURS per session Mon AM Mon PM Total Tues AM Tues PM Total Wed AM Wed PM Total Thu AM Thu PM Total Fri AM Fri PM TotalProvider A 0 0 0 0 0Provider B 0 0 0 0 0Provider C 0 0 0 0 0Provider D 0 0 0 0 0Provider E 0 0 0 0 0Provider F 0 0 0 0 0
Mon Total 0 Tue Total 0 Wed Total 0 Thu Total 0 Fri Total 0
Appointment Capacity versus Demand
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1
Monday Tuesday Wednesday Thursday Friday
Provider capacity Measured demand
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Supply Macro Supply…dept level Deployment of Supply…bookable hours Measures
Measure when schedule is released. Appts per session for each day of week per provider. Estimate % long and shorts based on prior schedules
Hours per session ? Productivity standard? Office FTE modification
Process of Supply… What is the work? Who does the work? What can we try doing differently?
Appointment Supply Worksheet
Week of:____________
Provider
A
Mon
Tues
Wed
Thurs
Fri
Sat
Total
Supply
Provider B
Provider
C
Provider
D
Total
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Measured demand
Calls for visits
Other external demand
Internal demand
# appt per day
Monday 44 2 29 75Tuesday 34 5 25 64Wednesday 29 8 35 72Thursday 30 3 18 51Friday 37 1 31 69
Provider capacity
# appt per day
Monday 70.125Tuesday 61.5Wednesday 87Thursday 58.875Friday 84
VISIT RATEVisits per hour
Provider A 3Provider B 3Provider C 2.25Provider D 3Provider E 3Provider F 3
HOURS per session Mon AM Mon PM Total Tues AM Tues PM Total Wed AM Wed PM Total Thu AM Thu PM Total Fri AMProvider A 3.5 4 22.5 4 12 3.5 2 16.5 4 12 3.5Provider B 0 2.5 3 16.5 2.5 3 16.5 0 2.5Provider C 2.5 4 14.625 0 4 9 3.5 4 16.875
Appointment Capacity versus Demand
0
10
20
30
40
50
60
70
80
90
100
Monday Tuesday Wednesday Thursday Friday
Provider capacity Measured demand
Apr-05 May-05 J un-05 J ul-05 Aug-05 Sep-05 Oct-05 Nov-05 Dec-05 J an-06 Feb-06 Mar-06 Apr-06 Average M T W TH FDemand 197 186 174 159 161 159 156 216 211 168 146 176 Demand 261 240 235 208 184Supply 171 179 195 179 201 176 164 192 174 150 118 173 Supply 193 190 162 195 175
S&D Average Weekly Averages
Supply & Demand
0
50
100
150
200
250
300
350
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
Day of the Month
Demand Supply
Average Weekly Supply and Demand
0
50
100
150
200
250
300
M T W TH F
Demand Supply
Family MedicineSupply & Demand Daily Average by Month
0
50
100
150
200
250
Apr-05 May-05 Jun-05 Jul-05 Aug-05 Sep-05 Oct-05 Nov-05 Dec-05 Jan-06 Feb-06 Mar-06 Apr-06 Average
Demand Supply
Tracking Demand and Supply source: YKHC, Bethel Alaska
Activity; the 3rd Dimension
Activity is the measure of patients who were actually seen today.
At the end of the day, regardless of demand or supply, count the number of patients seen.
Accounts for No Shows.
20
21
Three Dimensions;Demand, Supply, Activity
Average Supply & Demand December 12 - July 7
3 Appointments Per Hour
7975
60
73
82
63 62
5551 49
2732
24
33 35
0
10
20
30
40
50
60
70
80
90
Monday Tuesday Wednesday Thursday Friday
Supply Demand Patients Seen
Appointment Activity Worksheet
Week of:____________
Provider
A
Mon
Tues
Wed
Thurs
Fri
Sat
Total
Activity
Provider B
Provider
C
Provider
D
Total
22
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The latest…Demand, Supply, Activity
A three dimensional
look at what’s really going on in the practice.
All Physicians (Totals) - Office Visits (HG only)
0
100
200
300
400
500
600
700
800
900
1000
Sept Oct Nov Dec Jan Feb Mar Apr May
Num
ber
of Appts
Demand
Activity
Supply
Source: Huron Gastro, Ann Arbor
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Clinic Activity Availability
0
100
200
300
400
500
600
700
800
Jan-
03
Feb-0
3
Mar
-03
Apr-0
3
May
-03
Jun-
03
Jul-0
3
Aug-0
3
Sep-0
3
Oct-03
Nov-0
3
Dec-0
3
Jan-
04
Feb-0
4
Mar
-04
Apr-0
4
May
-04
Jun-
04
Jul-0
4
Aug-0
4
Sep-0
4
Oct-04
Nov-0
4
Dec-0
4
Jan-
05
Feb-0
5
Mar
-05
Apr-0
5
May
-05
Jun-
05
Vis
its Seen
Available
Scheduled
Demand… ScheduledSupply….. AvailableActivity…..Patients seen
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How to Track…How long to track…
Tic Marks vs Electronic tracking
4-6 weeks and then forever
Separating Internal from External
© Tantau & Associates
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What’s your situation?How do you know? D>S ? D<S ? D:S ?------------------------------------------------ “Our schedules are jammed every day.
Our Demand must outstrip our Supply”(??????)
“We’ve had the same Delay for months.” “We measure D and S, continuously and
map the trends.”
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If Demand is Greater than SupplyFour Options1. Work harder ?2. Delay the work ?3. Buy more supply ?
4. Do the work differently !!! …test…. Shape Demand Eliminate duplicate visits Care Team development; leverage the work Extend visit interval Promote Continuity Max Pack Simplify Appt types and times Nurse Appts Phone Appts Improve Access to reduce No Shows and capture that
Supply Spread
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Identify source of demand and ask, “Why?”
Internal External Discontinuity Single issue visits to ramp up visit count? Bumping Delays and defensive booking Sub-optimized Care Team Growth
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