Blue Skies

Great week!

Not because of this:

Our 3rd NAA is showing some improvement, but I’m not paying that much attention to it since I decided that “slow but steady” is going to win this race (see last post). We also discovered a measurement glitch last week. We use an electronic scheduling system and calculate the 3rd NAA using a “find next available appointment” feature. Last year we changed the way we use our electronic scheduler, to give doctors access to their surgical schedule via our EMR. We recently realized that this affected the way the program was identifying the next available appointment slot. The electronic result for 3rd NAA is slightly longer than the manually calculated 3rd NAA. This is a measurement artifact that will show up as a small drop in 3rd NAA as we start recording wait times calculated manually. It doesn’t change our patients’ experience of wait times.

No, the great thing about this week was a sign of a culture shift in our practice. We’ve been working to reduce our recall rates, in order to improve our capacity. In May, two of our partners had recall rates in single digits – down from their previous rates of around 20%. What happened?

Backlog, Schmacklog

“Get your body beach-ready!” trumpet the magazines lining the supermarket checkout. It’s an annual ritual for Canadians: Emerge from hibernation, decide to tone up and trim down, then embark on a crash diet and/or exercise.

But, to what end? Is a “beach-ready body” the ultimate goal? For some, it is; quick and dirty does the trick for them. For others, a slim physique is the eventual (but not certain) by-product of a different goal: a sustainable healthy diet and exercise program to achieve long-term wellbeing.

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We continue to struggle with our pesky backlog. Trimming the backlog will not only satisfy the primary goal of our Advanced Access project – improving patient access – but will also let us benefit from reduced administrative load and increased flexibility in physician scheduling. But, as Advanced Access evolved into a broader Clinical Practice Redesign project, our goal has changed also. Improving patient access alone (although a worthwhile goal on its own) doesn’t necessarily give our patients better care.

Liposuction can rapidly reduce someone’s corporeal backlog, yet they may continue to clog their arteries with cheeseburgers. In medical practice, a “brute force” approach to backlog reduction is the equivalent of liposuction. By working longer hours, cramming more patients into appointment slots, or recruiting temporary locum help, we can have a buff-looking practice, pronto. But when patients come through the door in 7 days rather then 70 days, they’re getting the same type of care as before the wait list slimmed down. (And having learned a lesson in my last post, let me point out that our current care is not bad. But, there’s always room for improvement.)

Tight Spot

A couple of summers ago, my family visited Scenic Caves near Collingwood, Ontario. As we hiked through the caves, we came to a cleft in the rock called “Fat Man’s Misery”. It’s a narrow gap in the rock that only slim people can squeeze through. The alternative route is to backtrack and take a slightly longer path.

My younger sons – then aged 8 and 10 – were amused at the thought of someone getting stuck in this crevasse. They thought it would be easy to pass through, and before I could stop them, they both did so. That left me with a problem.

A turn in the middle of the crevasse made it impossible for me to see the other end. I could see the passage narrowing as it turned. It looked like I would fit through the visible part, but I had no way of knowing whether it narrowed even further around the corner. Also, the passage was irregular and I would only be able to fit through facing one way. If there were any other rocky protrusions around the corner, I might get stuck in an awkward position.

Do You Recall

At the IHI Clinical Practice Redesign Summit in Vancouver, Advanced Access guru Catherine Tantau suggested that the gold-standard for specialist wait times is 1 week.
When wait times are that short, practices start reaping the benefits such as less wasted administrative effort, fewer no-shows and greater flexibility in physician schedules.

One week? It boggles the mind!

In early 2008, we were on our way with our 3rd NAA down to 30 days from our starting point of 70 days. Then, one partner switched to half-time work. Our 3rd NAA crept up a little until July 2008 when 2 more partners switched to half-time. Since then, our 3rd NAA has gradually climbed back to its original level. Aaaaaargh!