1. Shape Demand: Improving access is all about increasing the ability of the system to predict and absorb demand (patients’ requests for care). Reducing the amount of demand makes it easier for the system to absorb current or future levels of demand.
   
2. Match Supply and Demand: To improve access, clinics should balance supply and demand. If the demand is greater than supply, there is a delay in providing care. If the supply is greater than demand, then resources are being wasted. When supply and demand are matched, there is no delay in providing care.
   
3. Redesign the System: One way to increase a clinic’s ability to absorb more demand is to make the clinic more efficient. If an appointment now takes 45 minutes, but can be redesigned to take 20 minutes, then more patients can be seen on a given day. This doesn’t necessarily mean working faster, but working smarter. It doesn’t mean less time with patients; it means more quality time with patients.

Although the strategies are not arranged in a sequential order, most clinics find it useful to do the following:

• Know the extent of access delays
• Begin working down the backlog of appointments
• Match supply and demand by reducing or shaping demand and redesigning the system to increase supply

Many health care organizations have used the Model for Improvement* very successfully to test and implement changes. Using the key elements of the model, especially testing changes on a small scale with Plan-Do-Study-Act (PDSA) cycles,** has helped organizations improve patient access.

Including the right people on a process improvement team is critical to a successful improvement effort. Teams vary in size and composition. Each organization builds teams to suit its own needs.
Forming the Team

	Setting Aims Commitment to improving access is reflected by a strong and well-worded aim statement.
	Establishing Measures Collecting data on key outcome measures of access is the only way to determine whether access has improved.
	Selecting Changes Teams must test and implement changes in three key areas - shaping demand, matching supply and demand, and redesigning the system to increate supply - in order to improve access.
	Testing Changes The Plan-Do-Study-Act (PDSA) cycle is shorthand for testing a change in the real work setting — by planning it, trying it, observing the results, and acting on what is learned. This is the scientific method used for action-oriented learning.

Sources:

*Langley GL, Nolan KM, Nolan TW, Norman CL, Provost LP. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance.

**The Plan-Do-Study-Act (PDSA) cycle was originally developed by Walter A. Shewhart as the Plan-Do-Check-Act (PDCA) cycle. W. Edwards Deming modified Shewhart's cycle to PDSA, replacing "Check" with "Study."