Advanced Access scheduling made easy

Proven system eliminates long patient queues: docs

By Sam Solomon

Dr Kishore Visvanathan blogs about his Advanced Access experiment at www.hqc.sk.ca

When family physician Carla Eisenhauer told her fellow doctors at the Saskatoon Community Clinic in 2004 they could all but eliminate their wait times, most of them assumed she'd gone mad. Her patients were dubious, her receptionist told her it would never work.

"If you tell them that if you measure supply and demand, your demand is less than your supply, people say that's crazy," says Dr Eisenhauer.

But Dr Eisenhauer had done her homework. She convinced her colleagues to try a groundbreaking scheduling method called Advanced Access developed by Dr Mark Murray, a researcher with the Institute for Healthcare Improvement (IHI) in Sacramento which proposes to slash wait times and make same-day (or very short notice) booking possible.

"Might as well," one told her, resigned to the interminably long wait times that plagued the clinic, "it can't get worse."

He was right: it didn't. It got better — much better. The average wait time for an appointment began getting steadily shorter. Even the reluctant receptionist was convinced. "Within two weeks," says Dr Eisenhauer, "she walked into my office and said, 'I love it.'"

Her success has inspired a fellow Saskatooner, urologist Dr Kishore Visvanathan, to get his eight-physician practice started on an Advanced Access experiment, with Dr Eisenhauer on board as an advisor. Dr Visvanathan is keeping a blog (www.hqc.sk.ca) where colleagues can follow his clinic's progress.

WAIT TIME REVOLUTION
The average physician's supply actually outstrips the demand they face from their patients. Don't believe it? Just count the number of phone calls you get every day for a week, suggests Dr Eisenhauer. You may be surprised to find that you get fewer calls to schedule appointments than the total number of appointment time-slots you have. This is the case in up to 80% of physicians' offices, by some counts.

But, you may be asking, if it's so easy then why do I constantly feel like I am playing catch-up? After a crash-course in "queuing theory" Dr Murray realized something shockingly simple: variation, not imbalanced supply and demand, creates waiting times. In other words, your supply might vastly exceed your demand but if you cannot adjust to the variation in demand — the busy Monday after March break, the flu season flurry of activity, etc — then your wait time will begin to grow. To get rid of your wait time, you don't need to see patients faster, says Dr Murray. You just need to see them sooner.

SENSE OF SATISFACTION
Advanced Access has been used with great success by a number of facilities around the world, from the UK's National Health Service and the US Veterans Administration to current large-scale projects in Alberta, British Columbia and Saskatchewan and in individual clinics across Canada.

The results have been promising. Advanced Access projects have seen patient satisfaction rise, happier office staff, fewer no-shows and — most importantly — big cuts in wait times. Dr Eisenhauer's average wait time has dropped from 17 days to just two since she began using Advanced Access. "It makes you as a doctor feel so much better about life," she enthuses. "I used to go home and feel really tired — zapped. But these days I come out with a sense of satisfaction."