Friday, June 29, 2007

Gimme 5!

Our project goal: Reduce appointment wait times. Why? Well, because that would be good, right? Good for our office efficiency, the flexibility of our appointment system, and our financial bottom line. But ultimately, we want to improve the service we provide to our patients. Who gets to decide if we've succeeded? We could use our 3rd next available appointment time to show what a great job we're doing. But what waiting time will our patients be happy with? Two weeks? One week? Same-day service? I guess we'll have to ask them.

Patient surveys are completely new for us, as I suspect is the case for most physicians. After all, we're not really a business. Not like a car dealership. Wow, those guys are nuts for customer surveys. Every time I take my car in for servicing, they give me a card with an online link to complete a survey. If I don't do the survey, I get a reminder phone call. It's not good enough for them to know I'm getting my oil changed regularly, they want to know how I feel about it! Geez, you'd think they wanted satisfied customers or something.

When we started the Advanced Access project, we began giving out satisfaction surveys to patients checking in for their appointments. They're "experience" surveys because they don't just ask one all-inclusive question like "Were you satisfied?" Our survey breaks down various aspects of the patient's visit with us:

Friday, June 22, 2007

My Bad / My Learn

"You live, you learrrrrrrrnnnnnn." Alanis Morissette

I love this Quality Improvement stuff! No "mistakes", just "learning opportunities"! And I had a big one 2 weeks ago. Yup, learned something up real good.  

While Karen was out of town, I thought I'd try some number crunching on my own. Turns out that stuffing the wrong data into Excel and hitting the Chart button doesn't make you Nobel material. Who knew? Also, you're apparently supposed to "analyze" the data with "statistical techniques" rather than just eyeballing it and then going ballistic. In your blog. That anyone in the world can read.

In "Throw me a bone," I groused about our time to 3rd next available appointment starting to rise again, according to this graph:

Friday, June 15, 2007

Talking Dirty

“I don't wake up for less than $10,000 a day.”  Linda Evangelista

Warning: The following may not be suitable for people who think their doctor goes to work out of the goodness of his heart.

It’s time to address the 800 lb gorilla in the room: Money.

Universal government health insurance has, for some, divorced the delivery of medical care from payment for that care. For virtually all services I provide, patients are never aware that I get paid by submitting a bill under their name to the Saskatchewan government. It's a very sanitized process. I'm so used to it that I’m sometimes uncomfortable discussing payment for uninsured services with patients.   

Some physicians receive a salary, but many are fee-for-service, i.e., we get paid a fixed amount for each office visit or surgical procedure. We need to discuss this aspect of medical practice openly as it will be on physicians' minds as they consider adopting Advanced Access. Will their practice revenue rise or drop? Will there be any other non-monetary effects?

If we just consider Advanced Access as a way to balance demand and capacity, then it should be revenue-neutral. (Working down the backlog will increase fee-for-service revenue temporarily as more services are being provided.)  But AA has some benefits that aren’t immediately obvious.

Friday, June 8, 2007

Throw Me a Bone

“Are we there yet?” - Every kid since the dawn of time

Look at this crazy graph!

It looked like our 3rd next available appointment (3NAA) time was dropping, then, BOOM! it's back up again! What's going on? We're working hard on the backlog:

So why don't we see the 3rd NAA time dropping?

Friday, June 1, 2007

Preaching to the Choir

Sing. Sing a song. Sing out loud. Sing out strong. - The Muppets

This is a graph of reckless exhibitionism:

It is the weekly tally of hits this blog gets. It makes me break out in a cold sweat. People are finding out about this project. If we fail, we fail very publicly. "Specialists' waiting lists down to 2 weeks? Hah! I knew they couldn't do it..."

When we started, my first instinct was to keep things quiet. Let's be sure this is going to work before we spread the word. Then I mouthed off at a committee meeting. And got invited to present our project to another committee. And another. Then HQC asked me to write this blog. WWW = cat out of the bag.

Now that the word's out, I want to take advantage of it. I don't want to get carried away, but I have big expectations for this project. Way beyond improved access for the patients of one urology practice in one city. We're just the guinea pigs. If we can do it, why can't all specialists do it? And family physicians? All over the province! (Even WW! Read, wide world) Spread the word!

Who do we need to tell? Everyone reading this blog? Well, it's a start, but I suspect I'm preaching to the choir. (I wanted to say "QI-er" but a pun that bad is a sign of the Apocalypse.) Many people who follow this blog are already part of the Quality Improvement community. So, who else needs to know about this? How can we leverage publicity into action? Psst. Lean in close to the screen and I'll tell you: Grassroots. Forget top down. Let's go bottom up. Get the word out to the public, the people who are waiting for doctors’ appointments. Let everyone know that access can improve, and that it's already being done.