Plan of action is to have all pts tracked with data collection sheet for next xx months.

Will look at this as a factory - wil look at the range of times. Clear that wenneed to be more informative ton those pts that are waiting. When given reasons pts can still be pleased. Defining populations- and have agreement on this. Range of times for appts, maynhave to change the way we schedule. Right now the calendar is set only on MD time. In reality pt sees rn, np, etc... two things- have to be sensitive that our actual work reflects 70 of activity. 30% unpredicabilitybisnacceptable. Two have to be sensitivento what we offer, ie do we provide morenthatbwhat was sheduled for. Rather than jam all in, do we offer more or reschedule. Point- the longer you make a pt wait, for ex days, they are less likely tonchoose to go on study. Problem right now is that research rns not there. Right now no room in clinic and have to be paged. This unpredictability impacts the other pts, who may then complain. Question- can we find a space for research rns now? How to manage urgent pt issues. Next step is to expand to all pts for next 45-60 days. Assess and then define predicability. Third point- define the maximum number of types of pts and slots for each day. Then you will know the impact of adding more pts. Can never say "the inn is full"- would have public consequences. Take 15 minutes at breast conference next week to roll out. 7-7 NP clinic- at present Steve is looking at daily schedule and writing NP, then next appt is moved to NP template. Until recently, institute push was not to do NP clinics because we get paid less. Then came the question of low NP rvus. Plus MD wait times. Move to take all the survivors out of MD clinic can lead to physician dissatisfaction because they are then unable to see the success stories. Defeats the purpose of why people become doctors. We will try to balance business mindedness with patient care.

Define pt population, define range of times and build a table that reflects amount of pts and time. Do this for each provider and establish max capacity. Make it then known what adding each type of pts impacts the days. We need to be cognizant of not jeapodizing quality. Need to be sensitive to experience. -----------------------Need to regroup with Kim Sweeny. Will meet with all members of access that interact with breast service. -----------------------Notes for the retreat next weekWill look at jatinders slides. Share vision. Share info about the main areas we are looking at. Will work over emails on this and get together next Tuesday. Make sure that Ermelinda is invited to facilities meeting.