Improving Primary Care Access
The work of improved access revolves around closing gaps between supply and demand. Office practices have much more control over their supply than the demand. While more flexibility comes from managing the supply, there are times when demand may be gently shaped away from times we predict to be busy towards times we predict to be slow.
The first step in managing variation in demand is to know the general patterns of supply and demand in the clinic. Understanding these patterns allows the clinic staff to predict and anticipate variations that may occur. Once the patterns of supply and demand are known, predictions can be made and the clinic can plan to add more supply at certain times based on these predictions of demand. The best way to begin to understand supply and demand is to measure it, as discussed in Measure and Understand Supply and Demand.
The following are some practical ideas for managing variation in demand.
Manage demand-side seasonal variation:
Flu season, allergy season, snow-bird season, and school physicals are all examples of demand-side variation. Every year at most primary care clinics, an increase in demand for appointments during January and February can be predicted as the cold and flu season hits. Practices can make arrangements for physicians to add appointments to their schedules during these months or preferably preschedule elective visits into low demand seasons, months, and days. Scheduling elective and prescheduled appointments at low demand times anticipates needed openings during times of peak demand (as determined by an analysis of demand data).
Academic practices can anticipate dramatic shifts in supply that occur each summer as well as blocks of time when certain resident cohorts are unavailable due to other activities.
Utilize non-team members to see patients:
In the event that the patient’s provider or care team member is unavailable (either through absence or an unexpected demand on the day of the appointment request), a patient may be offered the option of being seen by another provider and/or member of another care team. This should only be done in rare circumstances since continuity in patient-provider relationships is key to achieving and maintaining optimal access.
Manage the daily and weekly demand and supply variation:
It is also important to manage variation in supply. Supply can vary as much as, or more than, demand. Variation in supply may result from unexpected sick days, leaves of absence, or even vacations that are scheduled late. To manage these variations, many practices use minimum provider staffing expectations to schedule vacations, days off, and the number of providers needed to staff on Mondays versus Wednesdays. On days when supply is greater than demand, clinics have agreed-upon assignments for staff such as max-packing visits that are scheduled, team meetings, etc., so that staff time can be used productively.
The holiday/flu season is a good example of the effects of variation in supply and demand. During the holiday season immediately preceding the flu season, there are often reductions in supply due to staff requests for time off for the holidays. Fortunately, demand usually decreases during this time as well. However, the pre-holiday reduction in supply can create a backlog of future appointments just as the practice heads into the flu season. For this reason, many practices strive to maintain the minimum staffing needed to match supply and demand during the holidays so that appointments are not put off to the future, creating backlog just as the high-demand flu season begins.