Friday, July 27, 2007

Keep those cards & letters coming!

In his book In Search of Excellence, Tom Peters describes project champions with phrases like "fired-up," "fanatic," and "zealot." I can relate to that. (He also uses "irrational" and "obnoxious." Ditto.) But even though I am still fired-up about Advanced Access, it's tough to keep up the enthusiasm when the project seems stuck in the summer doldrums. That's why it's such a great boost to read all the encouraging comments that you've sent.

But don't just send your comments to pep me up. Perhaps you'll read some feedback from someone in your own community. Get in touch with them! Build your own quality improvement network. You don't need to bite off a big project like this one; try something small. And then let us all know about it.

I’m most grateful, however, for the people who've given us license to make mistakes. Cathy Fooks wrote: "Not to say you must always deliver it." Sheri M wrote: "...we don't expect ourselves to be perfect!" Imagine how much we would achieve if we built a culture where well-intentioned failure is valued more than ineffective inertia. Thanks again.

A couple of weeks ago, we decided to try phoning patients with their appointment times. This idea came from a debate about whether we were "force-feeding" patients appointments by sending the times out in a letter. Stephen felt that we should make phone calls to give people the chance to negotiate a more convenient time for their consultation.

Here's the data collection sheet Amanda whipped up to collect the results:

Who needs a fancy spreadsheet?! This is a great example of how easy data collection can be for small tests of change. Most people were satisfied with the appointment they were offered (out of 16, only one person asked to change the date). There were a significant number of repeat phone calls necessary to reach some patients. Staff felt that this was a significant waste of time.  As such, we've decided to stick with the "old system" of appointment notification for now (i.e., letters sent out to all patients unless it's a very short time until the appointment, then we'll make a phone call).

The debate that led to this trial took up about 20 minutes at one of our project team meetings. In retrospect, we could have saved time by recognizing that we had a difference of opinion (phone call vs. letter) that could be resolved by some cold, hard data – and then getting on with collecting that data in a small trial. PDSA!


  1. Originally posted by Rosemary Gray (Lead, Practice Support Program, BC Ministry of Health) 7/27/2007 4:02 PM

    In BC we are in the midst of a large scale system transformation effort through the Practice Support Program. This includes providing support and funding for GPs and their office staff to take the risks of trying changes in their office, like: Advanced Access, CDM, Patient Self-Management; Group Visits. We have a target to engage with 1150 GPs (plus their office staff) to implement and sustain changes in one or more of these areas by September 08.

    We have Practice Support Teams in each of the 5 health authorities here, and many of the GP champions, MOA champions, and HA coordinators are uplifted and engaged by your regular reports on your progress, pitfalls, and the tips and tricks you've picked up.

    Personally, I'm enthralled - you're the consummate physician champion for Advanced Access! ....Despite the whole idea of champions generating all sorts of name calling among your peers :)

    I find your blog extremely motivating and helpful to address a number of issues we've seen arise here as we "roll out" advanced access.

    To add another name to the list, risk being grossly inappropriate, and bastardize a quote all in one fell swoop..... "Wild thing, we think we love you".

    Thanks for staying motivated. You're a great inspiration in more circles than you know.


    ...wanna come for a visit in BC to talk to a few people?

  2. Originally posted by Randi Clites (Parent from IFFC Conference) 8/7/2007 8:50 AM
    I have been reading your blog for a couple days now. As a parent who had no prior contact with health care (before my sons cancer and bleeding disorder dx), I have gotten spoiled at our local hospital with giving my "parent" feedback to create a more patient/family centered care, it is AWESOME to get your side of the struggles we all face.

    I am excited to see where this open dialog takes you!

    I should have asked for your autograph when we met!!!!