access and HYH use and drowning

[Guest guest]

NAncy and/or others:1. Why else do you not feel you a re " IMPing?'please2 .15 a day with staff sounds fine you have a receptionist and a husband yes?so financial safety comes first - are you breaking even and then are you supporting yourselves without outside work?

Do you know about how well open access is going? Is there much putting off of people to the next day or week or month?As to HYh I have two thoughts One isabout and secuirty There is no personal data of any patient retained in HYH Only aggregate data- how many women over 70 eg report htn etc is retained HAve contact me or Wasson about that becasue retaining false notions is silly Worrying about security is good .Thinking there are issues when there ar e not means you are losing access to a valubale service. You may not use HYH BUt to shortcut yourslef becasue of an " idea " about security that has been addressed by people smart enough to know what to do( eg way smarter than me), well that is just silly. So we should get you and PAul past that in case you want t o use this tool.

Ther e is ,i am hearing a real correlation here about how tyou guys can learn to make change, so you can use thos e skills to have the patietns make change.We want patietns to " just do " but we dont oursleves.(I i have been thinking about my endless flaws latelty)

As to people not having internet well that of course comes up all the time MY own HYH numbers are failry small but over 3 yrs now I have had plenty of people do it so that I can have feedback. I get two kinds of feedback

-one when indicivual patients send me their forms I know what is gong on with them, I see who has not had a pneumovax OR who has, but doesn't know etcI also get feedback on overall patient population preception of the practce;s ability to say give them confidence or access or whether I waste their time.

If you do not ask you will indeed get no responsesIf you were to find-in a simple painless way since I hear your fatgiue and imminent burnout- a way to use this tool then over time you have very useful information. but do not have to lift many fingers to get it.

Imagine some of your more diffiuclt patients who perhaps need more frequent visits or mor e phone calls etc suppose you used HYH with them and could get from that some intervention that would iprove outcomes for them That is the value

So we might want to come up with a way for you to stick you toe in the water A macro on a letter you already send? A link from a web site if you have one-- see NAncy Guinn's interesting post today The less she has a receptioist the more HYH gets done as she is doing online scheduling.

SOME people will do the online thing. SOme. Start there.If o n the other hand you are drownng under the weight of paperwork and scheduling and you cannot pay your bills that must be settled first.

Jean

I do not use HYH. I think because many of my patients do not have internet, nor will

be very open to using Internet (not secure enough, blah, blah,blah ) as well as I like

the personal touch. I use AC, and the summary page has all their meds, problems, specialists, tests

and such. I review it pretty much at each visit. I know we can do HYH on paper in the office, but

my patients have a hard enough time just filling out their " why are you here? " 2 line form. I could educate

them, sure, and may consider HYH.

I just realized that my biggest challenge is that to survive financially, here in a dead zone, I need

to see about 15 patients a day. HYH will be quite time consuming at first, don;t know if

\my completely disorganized mind can handle it right now.

To:

Sent: Tuesday, October 14, 2008 4:53:29 PMSubject: Re: access

So yeah I hear you saying " to get the practice up and Imping " but then you say you are, sofirsttell me why you do not think you are " Imping " Why do YOU think?

' and then tell me why you are. Offlist or on. Either (People will tell us if they want us to get off list becasue we annoy them)I would ask two for instances-1.Are you having a balance of patients- are supply and demand in balance? or are you not full, or are you too full and sorting that out?

2. Are you using HYH? that part is crucial (well to me . I know ,I will bring on someone saying but I am an IMP I just do not use HYH-- OK,OK but how you gonna prove it ? Good intentions do not make a plan)- wherein you get empowered patients that have confidence that they can problem solve, measuring your feedback on

access and efficency and seeing if the patients with many docs know who is in charge, seeing if YOU know and are not surprised by, the measures they self report as issues on HYH.And being obsessed is good . obsessed and driven towards quality and safety and the prusuit of happiness Or well 2 of those 3

Damn I was gonna be mature today but I guess it doesn't suit me..

On Tue, Oct 14, 2008 at 12:27 PM, nancy blake <nancycblake@ yahoo.com> wrote:

I hear what you're saying Jean. i agree, most patient's would not and do not abuse access. I have given nervous, new parents my cell phone #, and other patients as well. I do not mind the calls at the kids scoocer games, that doesn't bother me. And I recently was out on a Saturday, alone without kids (!) and a patient called. It's a 3+ hour wait at the Urgent Care. I told her meet me at the office, saw her for 5 minutes, everyone is happy.

My medical assistant, Michele, doesn't say " no " to patients. She says, let's see what we can do. She says let's talk about what works. Maybe the whole concern I have is getting this place up and IMPing, which we are pretty good at, but not completely, because of the access. I have someone cover for me once a year or so, but otherwise I am 24/7. Maybe I AM doing the right thing and don't even realize it...

From: <jnantonucci@ gmail.com>To: Practiceimprovement 1yahoogroups (DOT) com

Sent: Tuesday, October 14, 2008 10:54:12 AMSubject: Re: [Practiceimprovemen t1] access

On Tue, Oct 14, 2008 at 10:29 AM, <Jim.Kennedy@ uchsc.edu> wrote:

I think I agree with Jean!?

.. This is your first time?I am an acquired taste, they tell me...

-- If you are a patient please allow up to 12 hours for a reply by email/please note the new email address.Remember that e-mail may not be entirely secure/ MD

ph fax

-- If you are a patient please allow up to 12 hours for a reply by email/please note the new email address.Remember that e-mail may not be entirely secure/ MD 115

Mt Blue Circle ph fax

-- If you are a patient please allow up to 12 hours for a reply by email/please note the new email address.Remember that e-mail may not be entirely secure/ MD

ph fax

[Guest guest]

Jean

I missed the original phone calls for the next cohort. Do you know if we can listen to the podcasts and catch up or should I wait for the next podcast?

-- NOTICE: This email (including attachments) is covered by the Electronic Communications Privacy Act, 18 U.S.C. §§ 2510-2521, is confidential and may be legally privileged. If you are not the intended recipient, you are hereby notified that any retention, dissemination, distribution, or copying of this communication is strictly prohibited. If you have received this communication in error, please immediately notify the sender by email or by telephone at 1 and DELETE the original message from your system. Thank you for your cooperation.

" He is no fool who gives what he cannot keep to gain what he cannot lose "

[Guest guest]

OK, so it hit me thismorning. Why do I think I am not IMPing? The word "access". I was looking at is as a carte blanche to me. That I have to be there for the patient where and when THEY say. I am realizing it is not like that. A call from a patient this morning while I am out of the office. She really wanted to talk to me THEN. I called her back. She just wanted to know and feel secure that she could be seen today. She was seen, everyone's happy.

Will consider HYH...

To: Sent: Wednesday, October 15, 2008 10:21:13 AMSubject: access and HYH use and drowning

NAncy and/or others:1. Why else do you not feel you a re "IMPing?'please2 .15 a day with staff sounds fine you have a receptionist and a husband yes?so financial safety comes first - are you breaking even and then are you supporting yourselves without outside work?Do you know about how well open access is going? Is there much putting off of people to the next day or week or month?As to HYh I have two thoughts One isabout and secuirty There is no personal data of any patient retained in HYH Only aggregate data- how many women over 70 eg report htn etc is retained HAve contact me or Wasson about that becasue retaining false notions is silly Worrying about security is good .Thinking there are issues when there ar e not means you are losing access to a valubale

service. You may not use HYH BUt to shortcut yourslef becasue of an "idea" about security that has been addressed by people smart enough to know what to do( eg way smarter than me), well that is just silly. So we should get you and PAul past that in case you want t o use this tool.Ther e is ,i am hearing a real correlation here about how tyou guys can learn to make change, so you can use thos e skills to have the patietns make change.We want patietns to "just do" but we dont oursleves.(I i have been thinking about my endless flaws latelty) As to people not having internet well that of course comes up all the time MY own HYH numbers are failry small but over 3 yrs now I have had plenty of people do it so that I can have feedback. I get two kinds of feedback -one when indicivual patients send me their forms I

know what is gong on with them, I see who has not had a pneumovax OR who has, but doesn't know etcI also get feedback on overall patient population preception of the practce;s ability to say give them confidence or access or whether I waste their time. If you do not ask you will indeed get no responsesIf you were to find-in a simple painless way since I hear your fatgiue and imminent burnout- a way to use this tool then over time you have very useful information. but do not have to lift many fingers to get it.Imagine some of your more diffiuclt patients who perhaps need more frequent visits or mor e phone calls etc suppose you used HYH with them and could get from that some intervention that would iprove outcomes for them That is the valueSo we might want to come up with a way for you to stick

you toe in the water A macro on a letter you already send? A link from a web site if you have one-- see NAncy Guinn's interesting post today The less she has a receptioist the more HYH gets done as she is doing online scheduling.SOME people will do the online thing. SOme. Start there.If o n the other hand you are drownng under the weight of paperwork and scheduling and you cannot pay your bills that must be settled first.Jean

On Tue, Oct 14, 2008 at 9:00 PM, nancy blake <nancycblake@ yahoo.com> wrote:

I do not use HYH. I think because many of my patients do not have internet, nor will

be very open to using Internet (not secure enough, blah, blah,blah ) as well as I like

the personal touch. I use AC, and the summary page has all their meds, problems, specialists, tests

and such. I review it pretty much at each visit. I know we can do HYH on paper in the office, but

my patients have a hard enough time just filling out their "why are you here?" 2 line form. I could educate

them, sure, and may consider HYH.

I just realized that my biggest challenge is that to survive financially, here in a dead zone, I need

to see about 15 patients a day. HYH will be quite time consuming at first, don;t know if

\my completely disorganized mind can handle it right now.

From: <jnantonucci@ gmail.com>To: Practiceimprovement 1yahoogroups (DOT) comSent: Tuesday, October 14, 2008 4:53:29 PMSubject: Re: [Practiceimprovemen t1] access

So yeah I hear you saying" to get the practice up and Imping "but then you say you are, sofirsttell me why you do not think you are "Imping" Why do YOU think?' and then tell me why you are. Offlist or on. Either (People will tell us if they want us to get off list becasue we annoy them)I would ask two for instances-1.Are you having a balance of patients- are supply and demand in balance? or are you not full, or are you too full and sorting that out?2. Are you using HYH? that part is crucial (well to me . I know ,I will bring on someone saying but I am an IMP I just do not use HYH-- OK,OK but how you gonna prove it ? Good intentions do not make a plan)- wherein you get empowered patients that have confidence that they can problem solve, measuring your feedback

on access and efficency and seeing if the patients with many docs know who is in charge, seeing if YOU know and are not surprised by, the measures they self report as issues on HYH.And being obsessed is good . obsessed and driven towards quality and safety and the prusuit of happiness Or well 2 of those 3Damn I was gonna be mature today but I guess it doesn't suit me..

On Tue, Oct 14, 2008 at 12:27 PM, nancy blake <nancycblake@ yahoo.com> wrote:

I hear what you're saying Jean. i agree, most patient's would not and do not abuse access. I have given nervous, new parents my cell phone #, and other patients as well. I do not mind the calls at the kids scoocer games, that doesn't bother me. And I recently was out on a Saturday, alone without kids (!) and a patient called. It's a 3+ hour wait at the Urgent Care. I told her meet me at the office, saw her for 5 minutes, everyone is happy.

My medical assistant, Michele, doesn't say "no" to patients. She says, let's see what we can do. She says let's talk about what works. Maybe the whole concern I have is getting this place up and IMPing, which we are pretty good at, but not completely, because of the access. I have someone cover for me once a year or so, but otherwise I am 24/7. Maybe I AM doing the right thing and don't even realize it...

From: <jnantonucci@ gmail.com>To: Practiceimprovement 1yahoogroups (DOT) com

Sent: Tuesday, October 14, 2008 10:54:12 AMSubject: Re: [Practiceimprovemen t1] access

On Tue, Oct 14, 2008 at 10:29 AM, <Jim.Kennedy@ uchsc.edu> wrote:

I think I agree with Jean!?

.. This is your first time?I am an acquired taste, they tell me...-- If you are a patient please allow up to 12 hours for a reply by email/please note the new email address.Remember that e-mail may not be entirely secure/ MD ph fax

-- If you are a patient please allow up to 12 hours for a reply by email/please note the new email address.Remember that e-mail may not be entirely secure/ MD ph fax -- If you are a patient please allow up to 12 hours for a reply by email/please note the new email address.Remember that e-mail may not be entirely secure/ MD ph fax

[Guest guest]

Right Access does not equal lie down like a rug and be walked on .It means unfetter / get rid of /rules and barriers for people to access you ---> you get LEss demand more secure happier patietns

" rules " - not having " rules " - of course does not mean you can't have office hrs estabished! " rules " are allowed for say bedtime!It is the practice rules of you can only have aphysical at 3 pm so we are booking 4 months out or we only do acutes from 9-12 but you called at 1 pm, etc that block people from getting care.

Things like where rcan they park ,how they get off work , all of that blocks people form care. HYH just helps you measure itSee what happneds and let us know NAncy!

OK, so it hit me thismorning. Why do I think I am not IMPing? The word " access " . I was looking at is as a carte blanche to me. That I have to be there for the patient where and when THEY say. I am realizing it is not like that. A call from a patient this morning while I am out of the office. She really wanted to talk to me THEN. I called her back. She just wanted to know and feel secure that she could be seen today. She was seen, everyone's happy.

Will consider HYH...

To:

Sent: Wednesday, October 15, 2008 10:21:13 AMSubject: access and HYH use and drowning

NAncy and/or others:1. Why else do you not feel you a re " IMPing?'please2 .15 a day with staff sounds fine you have a receptionist and a husband yes?

so financial safety comes first - are you breaking even and then are you supporting yourselves without outside work?Do you know about how well open access is going? Is there much putting off of people to the next day or week or month?

As to HYh I have two thoughts One isabout and secuirty There is no personal data of any patient retained in HYH Only aggregate data- how many women over 70 eg report htn etc is retained HAve contact me or Wasson about that becasue retaining false notions is silly Worrying about security is good .Thinking there are issues when there ar e not means you are losing access to a valubale

service. You may not use HYH BUt to shortcut yourslef becasue of an " idea " about security that has been addressed by people smart enough to know what to do( eg way smarter than me), well that is just silly. So we should get you and PAul past that in case you want t o use this tool.

Ther e is ,i am hearing a real correlation here about how tyou guys can learn to make change, so you can use thos e skills to have the patietns make change.We want patietns to " just do " but we dont oursleves.(I i have been thinking about my endless flaws latelty)

As to people not having internet well that of course comes up all the time MY own HYH numbers are failry small but over 3 yrs now I have had plenty of people do it so that I can have feedback. I get two kinds of feedback

-one when indicivual patients send me their forms I

know what is gong on with them, I see who has not had a pneumovax OR who has, but doesn't know etcI also get feedback on overall patient population preception of the practce;s ability to say give them confidence or access or whether I waste their time.

If you do not ask you will indeed get no responsesIf you were to find-in a simple painless way since I hear your fatgiue and imminent burnout- a way to use this tool then over time you have very useful information. but do not have to lift many fingers to get it.

Imagine some of your more diffiuclt patients who perhaps need more frequent visits or mor e phone calls etc suppose you used HYH with them and could get from that some intervention that would iprove outcomes for them That is the value

So we might want to come up with a way for you to stick

you toe in the water A macro on a letter you already send? A link from a web site if you have one-- see NAncy Guinn's interesting post today The less she has a receptioist the more HYH gets done as she is doing online scheduling.

SOME people will do the online thing. SOme. Start there.If o n the other hand you are drownng under the weight of paperwork and scheduling and you cannot pay your bills that must be settled first.

Jean

On Tue, Oct 14, 2008 at 9:00 PM, nancy blake <nancycblake@ yahoo.com> wrote:

I do not use HYH. I think because many of my patients do not have internet, nor will

be very open to using Internet (not secure enough, blah, blah,blah ) as well as I like

the personal touch. I use AC, and the summary page has all their meds, problems, specialists, tests

and such. I review it pretty much at each visit. I know we can do HYH on paper in the office, but

my patients have a hard enough time just filling out their " why are you here? " 2 line form. I could educate

them, sure, and may consider HYH.

I just realized that my biggest challenge is that to survive financially, here in a dead zone, I need

to see about 15 patients a day. HYH will be quite time consuming at first, don;t know if

\my completely disorganized mind can handle it right now.

From: <jnantonucci@ gmail.com>To: Practiceimprovement 1yahoogroups (DOT) com

Sent: Tuesday, October 14, 2008 4:53:29 PMSubject: Re: [Practiceimprovemen t1] access

So yeah I hear you saying " to get the practice up and Imping " but then you say you are, sofirsttell me why you do not think you are " Imping " Why do YOU think?' and then tell me why you are. Offlist or on. Either (People will tell us if they want us to get off list becasue we annoy them)

I would ask two for instances-1.Are you having a balance of patients- are supply and demand in balance? or are you not full, or are you too full and sorting that out?2. Are you using HYH? that part is crucial (well to me . I know ,I will bring on someone saying but I am an IMP I just do not use HYH-- OK,OK but how you gonna prove it ? Good intentions do not make a plan)- wherein you get empowered patients that have confidence that they can problem solve, measuring your feedback

on access and efficency and seeing if the patients with many docs know who is in charge, seeing if YOU know and are not surprised by, the measures they self report as issues on HYH.And being obsessed is good . obsessed and driven towards quality and safety and the prusuit of happiness Or well 2 of those 3

Damn I was gonna be mature today but I guess it doesn't suit me..

On Tue, Oct 14, 2008 at 12:27 PM, nancy blake <nancycblake@ yahoo.com> wrote:

I hear what you're saying Jean. i agree, most patient's would not and do not abuse access. I have given nervous, new parents my cell phone #, and other patients as well. I do not mind the calls at the kids scoocer games, that doesn't bother me. And I recently was out on a Saturday, alone without kids (!) and a patient called. It's a 3+ hour wait at the Urgent Care. I told her meet me at the office, saw her for 5 minutes, everyone is happy.

My medical assistant, Michele, doesn't say " no " to patients. She says, let's see what we can do. She says let's talk about what works. Maybe the whole concern I have is getting this place up and IMPing, which we are pretty good at, but not completely, because of the access. I have someone cover for me once a year or so, but otherwise I am 24/7. Maybe I AM doing the right thing and don't even realize it...

From: <jnantonucci@ gmail.com>To: Practiceimprovement 1yahoogroups (DOT) com

Sent: Tuesday, October 14, 2008 10:54:12 AMSubject: Re: [Practiceimprovemen t1] access

On Tue, Oct 14, 2008 at 10:29 AM, <Jim.Kennedy@ uchsc.edu> wrote:

I think I agree with Jean!?

.. This is your first time?I am an acquired taste, they tell me...

-- If you are a patient please allow up to 12 hours for a reply by email/please note the new email address.Remember that e-mail may not be entirely secure/ MD

ph fax

-- If you are a patient please allow up to 12 hours for a reply by email/please note the new email address.Remember that e-mail may not be entirely secure/ MD

ph fax

-- If you are a patient please allow up to 12 hours for a reply by email/please note the new email address.Remember that e-mail may not be entirely secure/

MD ph fax

-- If you are a patient please allow up to 12 hours for a reply by email/please note the new email address.Remember that e-mail may not be entirely secure/ MD

ph fax