What Are the Factors Influencing Implementation of Advanced Access in Family Medicine Units? A Cross-Case Comparison of Four Early Adopters in Quebec
Table 1
The key principles of advanced access adapted from Murray and Berwick (2003) and Breton et al. (2016).
Key principles of advanced access
Definitions
(1) Balance supply and demand
To assess and understand, on one hand, the actual patient demand for appointments per physician per day, weighted by patient status and, on the other hand, the supply (e.g., number of appointments offered) in order to achieve the right balance between the two and match the demand to supply. Strategies to decrease demand for visits (e.g., max pack, extending visit intervals) or to increase supply (e.g., redesigning doctors scheduling system) are used.
(2) Reduce the backlog
To eliminate the previously scheduled appointments (wait list) through many strategies such as adding resources, increasing the supply of visits during a period of time. Communication strategies must also be put in place to inform and educate patients about the new advanced access model.
(3) Review the appointment system
To plan the physicians’ schedules over a short term (two to four weeks) and smooth out the demand for visits in order to offer same day appointments for acute and urgent cases.
(4) Integrate interprofessional practices
To develop or enhance the interprofessional practice between physicians and other healthcare professionals (e.g., nurses). Professional roles need to be optimized and tasks need to be clarified to meet patients’ needs in a timely manner.
(5) Create contingency plans
To plan for seasonal increases in demand and to develop coverage plans for replacing medical staff or other healthcare professionals on vacations and during illness periods. Many strategies are applied such as increasing the number of slots prior to leave and after returning on duty, hiring temporary providers, distributing and matching staffing competencies to demand. Integrating the collaborative and interprofessional practice facilitates planning for periods of absence.
