Friday, May 2, 2008

Cutting the Cord

When I decided that this would be my final Adventures in Improved Access blog post, I was struck with the parallels between our Advanced Access project and some changes in my personal life.

Last month, my eldest son moved away from home. He’s only a 5-minute drive away, and I see him frequently, but I wasn’t prepared for the mixed feelings I’ve had about his departure. I’m looking forward to a new relationship with an independent young man, yet I’m missing (somewhat) his regular presence around the house. On reflection, I think I’m unsettled by the fact that this change in his life signals a major change in my life.

With three children still at home, my wife and I are at least a decade away from being empty-nesters. Still, having our eldest move out heralds a new phase. Raising children brings new experiences almost daily, and the excitement of watching them grow and discover the world. Parents revel in our children’s success and wince at their failures (necessary though they may be). Our goal, as parents, is to raise happy, successful, and independent people, and then let them find their own way in life.

We’ve been having similar growth and change with our Advanced Access project. Karen has been our project advisor since its inception over a year ago. She has other duties to pursue and has let us know, over the last several weeks, that she’ll be withdrawing from the project’s ongoing management. We’ll collect and analyze all our data in-house, and continue with regular meetings with me, Donna, and Amanda, to keep the effort going.

Stephen, our patient representative, has indicated that he would also step down from the working group. His membership in the working group has changed our culture to the point that we ask the question (if he is ever absent from a meeting), “What would Stephen say about this new initiative/change?”

Likewise, Carla, our family physician colleague, will step back from regular involvement. All three of them have contributed enormously to the success of Advanced Access so far, and have graciously offered to consult if we need their advice.

We've also reached a significant milestone with the achievement of a new, stable system of reduced wait times.

So it looks like our little project is growing up and becoming more independent. I think I’ll miss all the discoveries when everything was fresh and unexplored. But, I’m also proud of the accomplishments we’ve made so far. (Latest 3NAA below).

Because of these changes, I felt it would be a reasonable time to stop blogging about our progress. After all, it looks like the exciting part of this project is finished. Although we’ve still got a way to go until we hit our goal of a 14-day 3NAA, we’ve shown we can make a change, and make it stick.

And so, with my son’s departure fresh on my mind, I decided to sign off on this blog.

And then he called me about his broken bed frame. He wanted to borrow some tools and needed some advice about making repairs. My first thought was Hey, figure it out for yourself, Mr. Independent. Then I realized I still have an important role to play in his life, even though he’s no longer under my roof. Perhaps this role is even more important than before, given some of the challenges and choices facing young adults. (Okay, so a broken bed frame is not earth-shattering, but it’s still an example that he’s not completely self-sufficient yet. Work with me here!)

So, I’ve reconsidered giving up this blog. Maybe our project won’t be as exciting next year as it has been for the first. But, we’ll still be making changes and exploring ways to improve our clinical practice. Perhaps these changes in the project are a risky time for us. As the team shrinks, will we lose our motivation? Could the improvements we’ve made slip back to the old way of doing things? I’ve heard of other improvement projects that withered after the excitement of the initial success faded. Maybe it will be important to document this phase of Advanced Access to let others learn from our mistakes. Maybe the continued public exposure of our project, in this blog, will motivate us to carry on.

We still have some questions to answer: How will we manage our reduced capacity when docs are on summer holidays? I’m also interested to find out what comes of our recall rate measurements. Is there really a stable system in which some of our docs are generating internal demand/recalls at a higher rate than others? How will our “default pooled referrals” trial (starting yesterday) work out? Will it be accepted by referring physicians and patients? What changes will we eventually make to further reduce our 3NAA?

In the same way that parents want to see their children eventually become independent, our goal for Advanced Access has been to make it self-sufficient in our practice. It’s time to cut the cord and set out on our own.

And it looks like you’ll still be reading about our progress... at least until my next midlife crisis.


  1. Originally posted by Lou 05/02/08 2:00 PM

    This has been really interesting to watch and enjoyable to read. I'm wondering if you will replace Stephen and continue with patient input as part of your 'new way of doing business'. My guess is that you'd do well to replace departing members of the team - there are always new challenges around the corner.

  2. Originally posted by Joy Dobson (Anesthesiologist , Regina Qu’Appelle Health Region) 05/05/08 12:45 PM

    Kishore, you made the right decision to keep on blogging. It is almost as good as having a patient on your team for keeping the intensity up! And we still need you to lead the way...

  3. Originally posted by Patrick McGrath (IWK Health Centre Halifax) 05/15/08 4:00 PM

    Enjoyed the blog and learned a lot. Great work.