Table 1

Steps to implement advanced access

1. Determine and balance supply and demandUsing a simple tally sheet, prospectively measure daily demand for appointments by patients (external demand) and physician recall (internal demand).
Supply is easy to calculate, as it is simply a measure of the number of appointments the physician offers in a week. This allows return visits to be reallocated to low-demand days and physician shifts to be rescheduled for high-demand days.
2. Eliminate the existing backlogThis is done once and up front, and requires any or all of the following:
  • adding capacity (eg, longer shifts, extra shifts, extra physicians);

  • choosing a target start date and not allowing prebooked appointments beyond that date; and

  • making the most of each visit with the patient by not deferring work to future appointments.

3. Simplify appointment typesStandardize appointment lengths (eg, 15 minutes) and use multiples of that standard appointment, if necessary.
Do not “reserve” emergency appointments. There should be enough capacity to meet each day’s patient demand.
4. Monitor and plan for variationsMonitor and plan for variations to supply and demand due to busy times, planned absences, epidemics, etc.
  • Adapted from Knight et al.7