What is Advanced Access?

Advanced Access is an innovative approach to primary care that aligns with Virginia Garcia’s customer focus by giving the patient what they need when they need it, while improving staff satisfaction and care delivery. Advanced Access improves both patient satisfaction and staff productivity and increases Virginia Garcia’s ability to see new patients. Advanced access means that Virginia Garcia clinics can offer patients an appointment or other connection with their provider of choice at a time that is convenient for them.

Goals of Advanced Access:

Advanced Access aims to offer an appointment today for any problem, urgent or non-urgent, with the Primary Care Physician (PCP), or team provider in the absence of the PCP. The motto of Advanced Access is: In order to protect tomorrow, we pull work into today. We do today’s work today. Today and the future are open and available for booking appointments.

Keys to Success:

Putting several key strategies in place can ease the transition to Advanced Access and ensure success. The following are keys to success for Advanced Access:

  • Training, follow-up training, and periodic refreshes
  • Teamwork: optimized workflows, huddles
  • Active daily management of provider schedules; contingency planning for mismatches
  • Nurse visits for standing order protocols
  • Group visits
  • Maximizing the current visit when possible by taking care of health maintenance and other concerns at the same time.

Elements of Advanced Access:

Advanced Access requires high leverage interventions to improve patient access to care. Major elements include:

Balancing demand and supply daily. When supply and demand are balanced, it is possible to “Do Today’s Work Today” and tomorrow’s work tomorrow. To achieve equilibrium in supply and demand, a clinic must routinely identify the number of providers (supply) needed per day for patient appointments, and adjust schedules to meet the demand.

Reducing the backlog. A supply and demand mismatch results in delays in patients accessing care, a “backlog”—too little supply or too much demand. The result is inefficient and ineffective care. Eliminating backlog requires a comprehensive plan that allows for increased access—and a lot of hard work — until the backlog has been worked down. The Care Team works the backlog together, with the initial help of a SWARM team that moves from clinic to clinic as each implements Advanced Access.

Decreasing appointment types. Reducing the carve-outs for specific appointment types opens up the schedule for patients to more likely be seen at a time that works for them, regardless of the issue/complaint. Follow-up appointments are still prioritized to the morning slots, saving afternoon slots for more urgent issues.

Reducing demand for visits. The Team scrubs the schedule daily by asking if all appointments are necessary. Could they be converted to an RN or Pharmacy visit? Could a telephone visit work as well? This intervention is always used with the understanding that the goal is to maximize continuity by having all patients seen by their PCP or at least by the Care Team.


In December of 2015, Virginia Garcia presented their work on Advanced Access at the IHI Conference in Orlando, Florida. Click on the image below to learn more about innovative approaches to patient access:

 

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Learn more about the following strategies:

RN Visits

Contingency planning for provider absences

Metrics (Coming Soon!)

Training Plans