Friday, April 20, 2007


December, 2006. Orlando, Florida.  What excitement!  This place is incredible!  Disney World?  No, I'm attending the annual conference of the Institute for Healthcare Improvement (IHI). Over 5,000 people are at this international clearinghouse of ideas and techniques for - you guessed it! - Improving Healthcare. Everyone seems so thrilled to be here, it gives the conference centre a theme park atmosphere.

I've been to some great sessions, but have pretty limited expectations for the next one: "Improving Access to Primary Care". My urology group has a long wait for consultations - about 3 or 4 months. We'd like to see patients sooner, but we're all working full out as it is. The brochure says the presenter, Mark Murray, has successfully improved access to primary care in many American centres. That's great, but specialty practice is very different. Well, maybe I can pick up a few tidbits.

"Are there any specialists in the room?"

What?!  Is he going to kick us out? Family physicians only? A few hands go up - mine too.

He points at me.

"What's your specialty?"

"I'm a urologist."

"Great! I was at a urology practice recently. How about if I pick on you as an example?"

And he does. For the price of admission, I get a 2 hour tutorial on how to apply the techniques of Advanced Access (or Improved Access, whatever you want to call it) to a specialty practice. It sounds too good to be true. Seeing patients within 5-7 days of referral?  I'll believe it when I see it.

After the session, I have lunch with Mark Ogrady, an ENT surgeon from Regina.

"Mark, you won't believe this. I just went to a session where this guy says he has a system where patients only wait a week to see a specialist..."

"You mean Advanced Access?  I've been doing that in my practice for 2 years. It works great."

My gaping jaw gives Mark an unflattering view of my egg salad sandwich. "You do this?"

"Sure, plus, the Community Clinic in Saskatoon does it, along with several other family docs. If you want some help with getting started, the Health Quality Council has people trained in Advanced Access. Their office is only a few blocks from yours."

It sounds like a great idea - maybe when I find some free time..

A few weeks after the IHI conference, I get a call at home.

"Kishore?  It's Karen Barber from down the street. I just took on a position at the Health Quality Council and as part of my professional development, I need to facilitate a quality improvement project. I heard you're interested in implementing Advanced Access in your urology group..."

Whoa. That's just a little spooky. First, I'm singled out in a room full of family docs in Orlando. Then I find out specialists in my own province are already doing this Advanced Access. Now my neighbor from down the street is offering to help implement this in my practice!   Destiny? Fate? Call it what you will -when the planets align, maybe it's best to go with the celestial flow.

So that's how this started. In these reports, I want to share our project with you. Successes and setbacks. Hard data and emotions. Challenges and insights. What it's like to attempt a quality improvement project in a busy practice. I'm excited about the chance to offer this to my patients. I hope you'll find something helpful in our experiences.

Real-time Spoiler Alert!

We started planning this project in January 2007, so the reports will be retrospective. However, from time to time, I won't be able to resist a little real-time update. If you don't want to read the ending before the whole story is told, skip these updates!

This week, I started scheduling extra offices to work down my backlog. All the people I saw had been referred within the last 3 weeks. Several commented on how pleased they were to have their appointments so promptly. That was very satisfying. I could get used to it.

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