IHP 505 Module 7 Milestone Three Example

Milestone Three: Implementing Same-Week Access at Northgate Family Medicine

[Student Name]

Southern New Hampshire University

IHP 505: Leadership in Clinical Microsystems

Module Seven Milestone Three

[Instructor Name]

[Date]

Milestone Three: Implementing Same-Week Access at Northgate Family Medicine

The first two milestones established Northgate's access problem and the evidence for advanced access and team-based care. This milestone sets out how the clinic will implement those approaches: the sequence of work, the daily huddle that will hold it together, the small tests of change, roles, timeline, measures and risks. The plan aims for a third next available appointment of 7 days or fewer within nine months while reducing after-clinic documentation.

The Sequence of Work

Murray and Berwick (2003) described advanced access as a set of changes adopted in a deliberate order. Practices first measure daily demand and supply so they understand the gap. They then work down the backlog of future appointments through a temporary increase in capacity, because opening same-day slots without clearing the backlog simply moves the wait. At the same time, they reduce appointment types and plan for predictable surges. Finally, they keep supply and demand in balance through ongoing measurement and by shifting work that does not need a visit. Northgate's plan follows that order across three phases.

Phase One: Prepare and Measure

In months one and two, the team continues daily demand and supply counts, reduces appointment types from seven to two, moves routine refills and test result calls to the care manager and medical assistants under standing orders and adjusts schedule templates. Staff help design each change in a series of short working sessions, and the practice manager explains the plan at an all-staff meeting.

Phase Two: Work Down the Backlog

In months three through five, the clinic will reduce the backlog of about 1,100 future appointments. Six volunteer clinicians will each add one extra session every other week, paid as extra time, and medical assistants will call patients booked more than three weeks ahead to offer earlier visits, phone follow-up or care manager visits where appropriate. The goal is to cut the backlog in half while protecting clinicians who did not volunteer from added load.

Phase Three: Open Access and Sustain

From month six, each clinician's schedule will hold about 60% of slots open until the same week, with contingency plans for Mondays and the flu season, such as flexing the nurse practitioner's schedule. Weekly measurement will guide adjustments.

The Daily Access Huddle

Provost et al. (2015) studied huddles in health care and found that these short, regular meetings help teams make sense of complex, changing conditions, surface problems early and strengthen relationships among team members. They described huddles as a practical tool for high reliability in settings where plans often meet surprises. Northgate's ten-minute huddle, held before the first patient each day, will include the front desk, medical assistants, the care manager and clinicians. It will review the day's open slots and expected demand, flag patients needing preparation, identify staffing gaps and ask what is not working. A simple whiteboard will show yesterday's third next available and no-show counts.

Testing Each Change

In a review of improvement reports by Taylor et al. (2014), most teams labeling their work as PDSA skipped the small, repeated, predicted tests the method depends on, one reason results vary so much. Northgate will test each major change on a small scale first. For example, the two-appointment-type template will be tested with one physician for two weeks with a prediction that her third next available will fall by at least five days, and phone follow-up by the care manager will be tested with twenty diabetes patients before expanding. Each test's prediction, result and decision will be logged.

Table 1. Initial Tests of Change

Note. Each test is reviewed at huddle before spreading.

Communicating with Patients

Patients need to know that the way appointments work is changing. The front desk will explain the new approach when patients call: routine visits can now usually be booked within the week, and patients do not need to book months ahead. A short notice in the waiting room and on the patient portal, in English, Spanish and Vietnamese, will explain the change and invite feedback. Patients who habitually book far ahead may be anxious that no appointment will be available when they need it; staff will reassure them and track whether that anxiety is justified. The patient advisory group will review the wording before it is posted, so that the message is clear to people with limited reading skills and does not sound like a reduction in service.

Roles

The practice manager leads the project and the huddle. The lead physician champions the changes with clinicians. A front-desk lead and a medical assistant lead represent their roles on the design team. The care manager leads phone follow-up. The health system's population health analyst produces a weekly access report. Roles were agreed at a team meeting, and the design team meets for thirty minutes every two weeks.

Measures

Third next available appointment for each clinician and the no-show rate are tracked weekly on run charts. Process measures include daily demand and supply, backlog size and how many same-day callers get a Northgate visit rather than an urgent care referral. Balancing measures include after-clinic documentation time, staff overtime, continuity with the patient's own clinician and a monthly one-question staff well-being check.

Risks and Responses

The chief risks are staff overload during backlog reduction, clinician resistance to fewer appointment types and gains fading after the project. Responses include volunteer-only extra sessions with pay, testing templates with a willing physician first and building the huddle and weekly measures into routine operations. If staff well-being scores fall for two months in a row, the design team will slow the pace.

Sustaining the Change

After month nine, the huddle, weekly access report and appointment templates become standard operations owned by the practice manager, with the lead physician reviewing access at monthly provider meetings. New staff will learn the approach in orientation, and the design team will meet quarterly to review trends and adjust.

Conclusion

The plan follows the advanced access sequence, anchors daily coordination in a huddle, tests each change on a small scale and measures access and staff well-being together. It gives Northgate a realistic path to same-week access that the team itself helps shape.

References

Murray, M., & Berwick, D. M. (2003). Advanced access: Reducing waiting and delays in primary care. JAMA, 289(8), 1035-1040. https://doi.org/10.1001/jama.289.8.1035

Provost, S. M., Lanham, H. J., Leykum, L. K., McDaniel, R. R., & Pugh, J. (2015). Health care huddles: Managing complexity to achieve high reliability. Health Care Management Review, 40(1), 2-12. https://doi.org/10.1097/HMR.0000000000000009

Taylor, M. J., McNicholas, C., Nicolay, C., Darzi, A., Bell, D., & Reed, J. E. (2014). Systematic review of the application of the plan-do-study-act method to improve quality in healthcare. BMJ Quality & Safety, 23(4), 290-298. https://doi.org/10.1136/bmjqs-2013-001862