Saskatchewan Health Quality
Council CEO Bonnie Brossart's latest project offers
to resuscitate physicians' practices |
Does your office's scheduling suffer
from an irregular rhythm? Have your staff's efforts
become anemic? Worried about bureaucratic asystole?
Sounds like your practice may be in need of some emergency
resuscitation, and a Saskatchewan-based training program
is here to help, with the promise of a brand new type
of CPR — Clinical Practice Redesign.
The new program, run by the Saskatchewan
Health Quality Council (HQC), will teach doctors and
their office managers about how to improve the clinical
and business aspects of their practices. The first session
of "CPR School" begins April 8; given the widespread
interest in the program so far, the HQC is planning
to expand it in years to come to accommodate more practices
from across Canada. "I think the demand is not going
to abate for this type of skills and knowledge," says
HQC boss Bonnie Brossart. "Frankly, I don't know of
any practice not challenged by the workload demands
they have."
PRACTICE
REVIVAL
The idea for CPR School — a set of three workshops
at the HQC's Saskatoon offices, plus three web seminars
and continued online support, over a period of seven
months — was initiated after several efforts to
help doctors and office managers whip their scheduling
and practice management techniques into shape failed
to really make a difference. "It was challenging for
them," says Ms Brossart. "They were too busy to study
how their practices worked."
That's where the new CPR School
comes in: the idea is that if they show the doctors
and office managers how to analyse how their practices
function (for instance, keeping data on how many new
visits or follow-ups are seen each day), then real change
will follow.
The endpoint goal is to help doctors
and office managers get to the point where they can
switch to a scheduling method called Advanced Access,
also known as same-day booking . In fact, the HQC staff
have gone as far as hiring one of the people who invented
the concept of Advanced Access as an advisor, the Californian
nurse and researcher Catherine Tantau. Essentially,
the theory is that your practice's capacity is actually
greater than the demand and if you can manage your scheduling
appropriately, it's possible to eliminate your wait
times and begin seeing same-day visits. This is done
by beginning to see all new appointments on the same
day they're made, while still seeing all your regular
appointments, until the backlog is cleared. Yeah, it
sounds crazy — but Advanced Access been proven
in American practices and, more recently, in a handful
of Canadian ones.
"It's a tough transition —
very challenging," says Ms Tantau. "But once people
see what is possible and experience improvement in their
day — good grief, who would want to go back to
practising with all the obstacles and burdens they have?"
Besides Advanced Access, CPR School
will also include lessons on improving management of
chronic disease patients and alternative ways of communicating
with patients, such as email and telephone follow-ups,
in an effort to make self-management easier.
DO
IT YOURSELF?
Many of these ideas are hardly new at all. So it should
follow that a resourceful physician collect some relevant
reading material from places like the US-based Institute
for Healthcare Improvement, learn the concepts and apply
them on her own, without a seven-month-long lesson plan
and without shelling out the HQC's asking price of $3,000
(or $4,500 for out-of-province physicians), right? Sadly
it doesn't usually work that way, say the experts.
"What appears to be simple is not
always," says Ms Brossart. "When you think about supply
and demand, how many people are working, scheduling
— it seems to be straightforward, but with the
nuances of how to change and modify them, I would suggest
self-teaching would be very difficult."
Nevertheless, some American practices
have been successful at self-teaching and implementing
the concepts behind CPR, admits Ms Tantau. "I've had
both experiences: 'We tried it and failed, can you help
us?' or, occasionally, I hear someone tried it and said
'It's the best thing we have ever done,'" she says.
"I think people are wise to get some help and support,
whether it's from us or a local health authority. This
is tough work. You can't dabble. It needs to be one
of your top three strategic goals or it won't happen."
At least several Canadian physicians
have been able to pull off the move to Advanced Access,
with varying degrees of success. Dr Mark O'Grady, a
Regina otolaryngologist, has been a devotee for over
three years now. Several other Saskatchewan doctors
have also made the change, including family physician
Carla Eisenhauer, whose wait times dropped from 17 days
to two, and urologist Kishore Visvanathan, who has been
blogging about his practice's experience on the HQC's
website (see Further Reading, above).
In an article published last month in Canadian Family
Physician, Halifax family physician Victoria Mitchell
wrote that her recent switch to Advanced Access brought
her wait time from 42 days to zero, eliminated no-shows,
improved continuity of care and made both her and her
patients happier.
To help the process along, suggests
Ms Brossart, physicians interested in trying their hand
at Advanced Access without attending CPR School might
want to consider hiring a consultant to come in and
help them out. Ms Tantau and her partner and co-inventor
of Advanced Access, Dr Mark Murray, offer consulting
services as Murray, Tantau & Associates; they have
experience working in Canada, with both family doctors
and specialists.
Given the steep price of CPR School,
self-learning, or hiring an expert for a brief consultation
may seem preferable to many physicians, though Ms Brossart
says the potential for savings from Advanced Access
reforms makes the program cost-effective. As well, the
Saskatchewan Medical Association and the provincial
government have stepped in to offer funding to pay the
full cost of tuition for ten of the thirty or so practices
that enrolled in this year's CPR School.
Another benefit of attending the
HQC's program in the future may emerge soon: Ms Brossart
says it's possible the program could be accredited for
CME if there's sufficient interest from physicians,
which she believes there will be. "I'm optimistic this
program is one that is going to be well received and
thought of in years ahead," she says.
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