Improving Primary Care Access
These change ideas of planning huddles, team meetings and staff meetings are also referenced in the change idea "Optimize the Care Team: Use Team Communication Methods." These change ideas (i.e., using huddles and meetings) apply logically to several of the ten ideas for improving access. For example, a huddle can be used by a team working to improve their communication, or by a team that needs to better manage its supply and demand. The creation of communication short-cuts and flexible cues and sequencing can also optimize team communication.
Huddles
To conduct a "huddle," the care team assembles at a predetermined time each day to look ahead on the schedule and anticipate the needs of the patients coming to the clinic that day. For example, a patient may need a potassium test before he or she meets with the physician. Instead of waiting until the patient is in the exam room with the physician, the staff can send the patient to the lab immediately after checking in at the clinic. Then the clinic staff can adjust the schedule because they know the patient won’t be using the original appointment slot, but will need a slot 30 to 45 minutes later after the test is conducted.
Start huddles with a small bit of work and grow the work as the team gains proficiency. For example, in their huddles, teams can discuss what patients on the schedule are unlikely to show up for their appointments (because they are in the hospital, they called to cancel, or were seen just last week), what equipment will be needed in the room, and what additional services the care team can provide for the patient at today's appointment to make a re-visit less likely. Lessons learned from the huddles are recorded and reviewed at weekly team meetings.
Weekly team meetings review lessons from huddles. The care team also needs concentrated time together to plan their roles and responsibilities, as well as to discuss opportunities for improvement in their work. Planned team meetings, scheduled weekly or monthly, are the most effective tool for accomplishing these types of important activities.
Staff Meetings
Weekly staff meetings are used to discuss the lessons learned from huddles as well as to identify issues beyond the care team. For example, a care team huddle may identify a problem with the location of a computer or the need to deflect patients away from the team due to reaching the limits of supply. Staff meetings are a good place to raise practice-wide staffing issues.
Production Planning Meetings
They review the next four weeks of supply compared to expected demand and manage the contingency plans to close any gaps. These production planning meetings review lessons from the teams, looking for patterns indicating systemic problems such as the following:
- Time off, vacation policies based on critical threshold
- Develop staffing requirements, space and equipment requirements
- Plan how much of a provider’s schedule to hold for another absent provider, discuss philosophy as well as numbers
