Friday, March 7, 2008


I’m leading with the stats (as of February 27) this week, because they are sweet!

Two weeks ago, I met with one of the university-based surgery groups to discuss Advanced Access. It felt like I was in that TV commercial where a man travels into the past to give advice to his younger self. Their group looked just like our group did one year ago when we first considered starting this process.

The division head was interested in Advanced Access because he (and his colleagues) realized that their patients were waiting too long for consultation appointments. Perhaps he'll be the clinical champion.

Other surgeons appeared skeptical. Again, this had a familiar air to it. Several openly expressed their skepticism. They began listing the reasons why Advanced Access wouldn't work for them: I’m too busy. I have research and teaching commitments. I can't increase my clinical load to work down backlog. We're already working as hard as we can.

Once again, it made me nostalgic for the time when we started our project. There were plenty of reasons why Advanced Access wouldn't work. I understand now how valuable it is to hear people voice those reasons. Some may be actual barriers, and others may just be individual perceptions, but all of these concerns need to be aired and addressed. I was encouraged that some surgeons were actually talking about these concerns.

I was most worried about one surgeon who didn't express any concerns. In fact, he didn't comment either way. I've seen that behavior in our project as well. It's the most difficult to deal with: the silent objector. If this person isn't engaged in the change, he can easily sabotage it. Even passive resistance will hamper progress. The project leader will need to be mindful to draw out that person's feelings about the potential changes then address any concerns and actively involve him in the initiative.

Best of all, the group's administrative staff attended and seemed interested in Advanced Access's potential.

I didn't sugar-coat anything. It's extra work for everyone at the start. Staff need to meet frequently to analyze current practices and decide what processes will be measured. Measurement tools need to be developed and baseline data is gathered. Initially, this will be unfamiliar to most staff, and it can be bewildering and intimidating.

On the bright side, I was able to explain some of the payoffs for implementing Advanced Access. The project sponsor/champion needs to sell it to the entire department. He'll need to put more on the table than just the noble goal of improving access for patients.

Physicians and staff should hear the direct payoffs they'll enjoy:
  • Job satisfaction through happier patients.
  • Fewer phone calls from family doctors asking for their patient to be moved up the wait list.
  • A less rigid booking system that accommodates physicians who have to cancel a day of office appointments because they want to attend a conference or take a vacation.
  • A forum for staff and physicians to collaborate on clinical practice redesign to improve other aspects of the practice.
  • More engaged and satisfied staff.

Hey, forget the champion... This thing sells itself!

It's time to start spreading Advanced Access. Even if we hit our own target (3rd next available appointment = 14 days), the real brass ring is sparking a culture change across the province.

But, maybe the circumstances in our office (perceived crisis, cohesive physician group, mentoring and support from HQC) were unique. Will lightning strike twice?

The frustrating part is that it's out of my hands. (Control freak? Who…me?) However, I will offer any interested physicians my recipe for a successful project:
  • 1 crisis (large)
  • 1 champion (any size)
  • Many cooks
  • Measure carefully
  • Season, taste, repeat
  • Keep on high heat until done
  • Serve patient first

Bon Appetit!!


  1. Originally posted by Tanis Rollefstad (Safety and Improvement Advisor, Safer Healthcare Now!) 03/07/2008 10:45 AM

    You're Brilliant! A true star in quality. And.... you're funny. A dynamite combo for the hard work of change. Keep it up!

  2. Originally posted by Darlene 03/07/2008 10:50 AM

    I find your update always very engaging. The recipe that you included today was right on! Your work/efforts remind me of the following quote (can't remember from whom!!): "Choose the right thing to do, and the do the right thing about it". Keep on advancing.....

  3. Originally posted by Nancy Thornton (Alberta Children’s Hospital; 03/07/2008 2:30 PM

    Do you know of this working in settings where many of the referred patients end up needing to be followed and managed for many years? We are interested in big change in our peds specialty area and need all the evidence we can find that this would be an approach to try. Please advise. Many thanks.

  4. Originally posted by Fay Puckett (retired RN) 03/10/2008 8:00 AM

    Great blog Kishore and Great work. I have been a fan of the Improved Access process since studying it at the Sask. Institute of Health Leadership in our group project, and as a patient at the Community Clinic. Your focus on service to your patients is commendable. I wish you well in your work and know that there are people out there cheering you on. Things can change.

  5. Originally posted by Gedeon J. Denis (patient) 03/17/08 11:35 AM

    I have been one of Dr. Visvanathan's patients since about early Feb-March 2003. I have great respect for Dr. Visvanathan's care and have great trust in his leading my care. I filed a complaint with the Saskatoon Health Region because I figured I had waited too long after the referral for what should have been "emergency surgery" (for me anyways). I was given a "guided tour behind the scenes" of the Saskatoon Health Region and saw how a referral for surgery winds its way through the allotments of surgical suites, recovery rooms, availability of nursing staff for different stages etc., etc. At the conclusion of this exercise we "agreed to disagree." I can say that Dr. Visvanathan had been able to get my surgery moved ahead by three weeks, and for this I am grateful. Dr. Visvanathan all I can say is "Keep up the good work" and I wish you the best. Hopefully one day the results we are starting to see in your clinic will also be visible in surgical wait lists.