Regular adjustment of supply to demand

Adjust supply and demand– Indicators of imbalance

To ensure that a balance between supply and demand is achieved and maintained, continuous follow-up using the schedule is important. In fact, to be able to respond to demand in a timely manner, the schedule should always have time slots reserved for urgent needs. Here are two access indicators you could use to do this.

Feedback mechanism

A feedback mechanism is a process by which administrative staff promptly notify a professional when patient demand exceeds their service supply, meaning that requests must be refused, postponed or referred due to a lack of available time slots in the schedule. Similarly, the professional should be notified if a large number of consultation slots remain unoccupied at the end of a period. To ensure that the feedback mechanism works properly, a link must be clearly established between the professional and the administrative staff and not rely merely on impromptu hallway discussions. Information can be conveyed in a variety of ways, including regular short meetings (daily, weekly or otherwise) or other forms of brief, regular and systematic communication. It is best to avoid specific exchanges for each additional consultation request.

To support the feedback process, the following information may be collected:  

  • The number of requests that were referred to another member of the clinical team due to lack of availability

  • The number of requests that had to be referred to the clinic's walk-in service due to lack of availability

  • The number of patients attached to the professional who actually visited the clinic's walk-in service

Use of the 3rd Next Available Appointment

The main indicator used in the literature to measure a professional’s accessibility is the 3rd next available appointment. In practice, it is a matter of identifying the 3rd next available appointment slot in the calendar, excluding those dedicated to specific populations and which are therefore not open to all (e.g., obstetrics, pediatrics, mini-surgeries, etc.). This involves counting the number of days between the current time and the 3rd available slot in the schedule (including weekends).

List of possible temporary strategies for use during periods of peak demand

  • Adding telephone or virtual appointments  

You may want to consider adding one or more time slots for telephone or virtual appointments. Teleconsultations usually require less time than an in-person visit and can more easily fit into your schedule, especially on days when you are not in the clinic.   

  • Reduce your walk-in service availability   

You may want to reduce the number of walk-in consultations that you offer. These consultations are a way to see some patients quickly, but they should be used only as a last resort, for example when a team member is absent. Walk-in appointments do not promote service continuity and do not take into account the principle of assessing the urgency of needs (smoothing out appointments) recommended in advanced access. Therefore, these slots should not be used to see your patients in urgent needs. Instead, these needs should be addressed during consultation slots reserved in your schedule for urgent requests.  

  • Reduce the length of your appointments

    During periods of increased demand (peak demand), you may want to reduce the length of your appointments to recover some time. A few minutes saved at each of your appointments can sometimes allow you to add an additional appointment during the day or at the end of the day.

  • Delegate certain administrative tasks to other team members 

You may want to revisit administrative tasks that do not necessarily require your attention and assign them to other members of the clinic team (administrative staff or health professionals), at least during periods of peak demand. For example, a CNESST, SAAQ or other insurance form can be filled out by a nurse and then finalized by the physician. For form requests, if the patient has been seen during the year, it may not always be necessary to schedule a consultation. The patient can drop off the form to be completed by the professional and then pick it up from the office later on. 

  • Review assigned appointments and identify those that could be seen by another professional on the clinical team 

You could review appointments already assigned for the current week or for the coming weeks to identify those whose reason for consultation does not require your skills or knowledge. These appointments could then be assigned to other members of the clinical team who can meet the need according to the expertise required. When doing so, be sure to prioritize members of the team whom the patient already knows or has previously met. 

  • Increase the number of appointment slots during the day, in the evening or on weekends 

In order to avoid accumulating a backlog and creating a waiting list, it may be beneficial to add, for a limited period of time, a few time slots during the day (for example, at lunch time or during times normally reserved for administrative tasks), in the evening or on weekends, depending on your availability. 

Advanced access strategies

In addition to the strategies used during peak periods, there are appointment management strategies that can be used on a more permanent basis.

List of strategies to optimize consultations at all times:

  • Elimination of annual exams for certain groups of patients (e.g., healthy young adults)

  • Adjustment of follow-up intervals between visits based on the level of stability of the patient, especially for monitoring chronic diseases or conditions

  • Maximization of consultation value by addressing multiple needs in a single appointment ("max pack")

The goal is to meet as many needs as possible during a single consultation in order to reduce the number of future consultations. This optimizes your time and that of your patients and increases your efficiency. This is because, at each meeting, information must be repeated and/or the situation must be reviewed, which can lead to a certain amount of "wasted time".

  • Establishment of a strategy to reduce missed appointments  

It is generally recognized that timely access, as well as shorter term for appointments, significantly reduces the number of missed appointments. Adopting the principles of advanced access should also help mitigate this issue. Nevertheless, if you notice a significant number of missed appointments despite adopting advanced access strategies, you may want to use personalized reminders. When an appointment is missed, a call can be made to ask about the reason for the absence and raise awareness about the importance of attending an appointment and the impact of missing an appointment on the professional, the clinic and other patients. A personalized reminder requires an initial investment of time but can reduce the number of missed appointments in the medium to long term. This strategy can be considered and adopted on a temporary basis until the culture change associated with an advanced access practice is fully integrated by patients. 

  • Renewal of prescriptions for more than one year

Some conditions do not require close monitoring of the patient. Therefore, the associated prescriptions can be renewed for more than one year, which reduces the number of visits required in the year. In addition, some prescriptions can now be renewed by your clinic’s pharmacist or by community pharmacists. 

  • Delegation of services or follow-ups to other members of the clinical team

Your clinic is comprised of several professionals with varied and complementary fields of expertise. They are your partners in patient care and can take on many types of appointments depending on their skills.

  • Promote the engagement of patients with chronic or specific conditions through self-management practices (e.g., by providing information about how to live well with certain health conditions, what to do, how to react when certain situations occur, etc.) 

It is important to encourage patient involvement and self-management. Those who know how to manage and live well with their condition require fewer consultations for small problems. 

  • Offer group appointments or "specialty clinics" (e.g., for follow-up of chronic diseases or certain conditions)

In collaboration with other professionals on the clinical team, you could meet multiple patients with the same health condition in a same session. For example, you could partner with a nurse, a nutritionist and a pharmacist so that patients can take turns seeing the members of the team involved in managing their condition on a particular half day. Patients can then receive information on the daily management of their condition as a group and consult each professional individually for personal follow-ups. Bringing together people with the same condition can optimize the desired effects by allowing patients to review the required information and follow-up in a single session, and perhaps discuss with other patients who have the same condition. Finally, group offerings allow the clinical team to more easily share tasks that need to be repeated. 

  • Delegate the follow-up of certain conditions or chronic diseases to community resources, for example a pharmacist

Other professionals in the community are now overseeing certain conditions, such as INR monitoring for anticoagulation therapy, which can be done in community pharmacies.