Third Next Available (TNA) - A Tool for Patient Scheduling?

Third Next Available, abbreviated as TNA or 3NA, is a calculation commonly used in medical practices to measure patient accessibility, or provider availability. The idea is to determine, at a specific point in time, the third available appointment slot for a specific appointment type. This represents a realistic time patients will have to wait on average to get an appointment with that provider for that specific appointment type (New Patient, Follow-up, Annual Wellness Visits, etc.). The reason to use the third next available and not the first next available is that the first next may have become available a few moments ago due to a cancellation or reschedule, so third next give a reasonable margin of error in calculating provider availability. The concept is to reduce the 3NA value to as low as possible, depending on the specialty, in order to improve patient accessibility to an optimum level.

The concept of appointment availability introduces a possibility of schedulers to think that this is an effective tool to use for scheduling. However, one must not forget that as soon as the first appointment is booked, the 3NA number could change considerably depending upon the new third next available appointment. It is best to use the actual provider schedule within the practice management system for determining the next available appointment. 3NA is a tool to be used for trending by calculating this week after week on the same day/time, and helps only t determine how busy the provider schedule is on an average. Based on this trend, the practice administration can determine if the provider schedule needs to be tweaked, or more resources need to be made available, or add another provider is appropriate. Keep in mind that 3NA makes sense for each appointment type individually, and comparisons between providers of similar specialties provides a better criteria to work off of.

It can, thus, be concluded that 3NA is not an effective tool to be used for patient scheduling, rather it is a measure of provider capacity to see patients in a timely manner or, in other words, patient access to a provider.

Excel Snippets - Grouping people by age groups

Every once in a while, every excel user would need to group people in a list by age group. The prerequisite for this task is either an age column, or date of birth (DOB).

In case you have the DOB column. the first step is to add and populate the age column. the quick and easy solution is using the following formula:

 =INT(YEARFRAC(birthdate, TODAY()))

Basically, this formula fetches the integer part of year fraction of difference between the birthdate cell and today's date.

Now comes the actual grouping part. This approach assumes a fixed number of years groups and an upper max (optional). For example, we may need to group from 1 to 15, 16 to 30... and so on till 61 to 75, and finally 75+ (everyone older than 75 years). To achieve this, add another column to the table and name it "What was I thinking?" or anything you feel like. Then add the following formula assuming  H2 is the first record cell for Age that you got from the formula above:

=IF(H2>75,"75+",INT((H2-1)/15)*15+1&"-"&(INT((H2-1)/15)+1)*15)

Copy this formula to all the other cells in the Age group column using the auto-fill feature of excel, i.e. double clicking on the lower right corner of the original formula cell (where the cursor changes to a +). It should automatically convert the formula reference of H2 to the corresponding row numbers like H3, H4, H5.....

A little explanation of what happens in the formula, in case you are one of those who really need to know:

1. H2 is the cell address from where age value is picked up. 
2. H2>75,"75+" adds 75+ to the group column if the age is greater than 75
3. If H2 is not greater than 75 then the second part kicks in.
4. INT((H2-1)/15)*15+1 calculates the lower limit of the 15 years interval in which H2 falls.
5. &"-" adds a hyphen after the lower limit value.
6. (INT((H2-1)/15)+1)*15) calculates the upper limit of the 15 years interval in which H2 falls.

Remember, we decided in the beginning that we want to group into 15 years intervals with an upper limit of 75+. You may modify the formula to any other grouping simply by changing the 75 with whatever you want the upper limit to be, and replace all the 15s by the group intervals in years. For example, if you want to group into 5 years intervals with an upper limit of 55 years, your formula would be:

=IF(H2>55,"55+",INT((H2-1)/5)*5+1&"-"&(INT((H2-1)/5)+1)*5)

So there you go, age grouping conquered, next we move onto adding a wildcard search term in the IF statement to identify columns containing a certain text string anywhere within the cell contents.

METRICS and OMTM

Definition as it pertains to businesses:

A business metric is a quantifiable measure businesses use to track, monitor and assess the success or failure of various business processes. The main goal of measuring business metrics is to track cost management, but the overall point of employing them is to communicate a company's progression toward certain long- and short-term objectives.

Consideration for business metrics:

1. Should be a Rate or a Ratio, mere numbers/quantities do not provide a sense of good, bad or better performance.
2. Should be a comparison over a period of time, or with other sites, segments.
3. Should be easily understandable, complex metrics create misunderstandings.
4. Should lead to change in behavior towards better performance.

One that matters -- One Metric That Matters (OMTM):

Identify the most important Metric to measure the overall health of the department.

1. Not a One Size Fits All metric. Every department, organization and situation will influence what is most important at the point in time.
2. Once selected it is not set in stone and is subject to change based n prevalent conditions.
3. Not a set it and forget it metric. Continuous monitoring and tweaking required.
4. Not a Carte Blanche to forget all other lesser important metrics.

Move on...

 We have email notifications turned on for our hoe phone, so we get an email for all incoming calls showing the number and CLI if available. We have been debating giving up the land line at home and utilize a google call number instead for this purpose. The sole reason for retaining the phone line is that the FIOS Triple Play package for phone, internet and cable is cheaper than just getting the cable and internet. Go figure why a bottle of water costs more than a bottle of soda. At some point when we may decide to give up cable all together we will drop the phone line as well. Currently we have the lowest tier local TV channels without the set top box, another cost saving factor.

 Yesterday at work around noon my Samsung S2, on loan from my son, while he un-jailbreaks his phone for the watch to work, buzzed on my wrist indicating a new email has arrived and when I tapped on the notification it showed a call at home number from Nick's school. I remembered that if there is an emergency they would call Sara or me on our cell phones. since it was close to noon, I waited for the lunch break and then asked Sara and indeed she had received a call from school about Nick bumping into a pole but nothing serious, just a bit shaken up. Sara had talked to him and all was okay.

 Back home in the evening after dinner I was sitting in the living room next to Nick sipping my after dinner tea slowly and enjoying its soothing effect. he was doing his online homework on the laptop, when I remembered the phone from earlier in the day. So i asked him where he got hurt and he point at the backside of his head, and that it doesn't hurt any more. I was a bit intrigued  how he bumped into a pole and hurt the back side of his head, so asked him how exactly he bumped into the pole.He got up and demonstrated by moving backwards a couple of steps and then hitting an imaginary pole. I immediately identified an opportunity for a lesson and got into the time to teach (TTT) mode. I asked, " So what did you learn?". Nick replied, "Learn when?". Me, "during the PE period". Nick, "in PE we just play, we don't learn anything". I was still too deep into my TTT mode and decided to rephrase my question, "I meant what did you learn from the accident?". Nick responded, "What accident?", and I clarified, "when you bumped your head into the pole". I was very confident that Nick will be wise enough to say " I learned that I should watch where I am going so I don't get hurt". Nick started off, " I learnt that..." and my chest expanded another 2 inches with pride and anticipation of accomplishing my goal, "... that when you bump your head into hard things, it hurts for a while." He continued, " it doesn't hurt any more and i had almost forgotten about it until you reminded me. Can we talk about something else?". And that's when the teacher became the pupil and I realized that a 7 year old taught me to live in the present, and move on from things that don't matter any more, and enjoy life more instead of evaluating everything that happened and deducing conclusions.

We should be grateful for the life we have and move on from the little bumps n life. I am pretty sure Nick will still walk backwards, and did not need a lecture from me to learn that he should be careful while walking backwards and clear out his path before doing that. But the bigger lesson he learned and taught me was that bumps in life hurt a little for a little while and then all will be fine unless you keep thinking about it.

Thank you Nick.....

Kaka....

The timing of our FSc. Exams at PAF College Sargodha left us in the middle of nowhere and the authorities in a quagmire to figure out what to do with us. We could not join CAE in the middle of a term/semester, and we had nothing to do at Sargodha College. Against all our hopes of getting prolonged vacations, the authorities planned to keep us in Sargodha and planned various activities (read route marches) to keep us busy. Our daily route marches constituted of donning cotton coveralls and going in random directions, roaming around aimlessly under the supervision of GST staff. Picking oranges from the numerous orange groves in the area, and playing cricket in a dirt stadium became our favorite activities. Finally, the day came when everybody got tired of us and decided to give us a brief vacation before reporting to CAE Korangi Creek in March of 1984.

Incidentally, we reported to CAE during the end semester break and there was hardly anybody in the cadets mess. We got a pretty laid back welcome and soon realized that Sargodha had dumped their problem of what to do with us over to CAE. We were subjected to some mild activities including morning assemblies, marching over to the Academics block and spending time filling up random forms in the college auditorium. They even came up with an idea of turning off the lights and asking us to take naps. Quite frequently we were left on our own and checking back occasionally to give us the notion of being supervised.

Gotten bored of just sitting in the darkly lit auditorium, one of our course mates decided to try his skills at making an airplane, something we all had aspired to when we applied to study aeronautical engineering. With the limited resources and even more limited knowledge, the result was a paper airplane that flew in loops before spiraling down to the floor. Then someone suggested to make the paper rocket  plane that had a longer range compared to the smaller plane which had more endurance. The suggestion was well received and our friend took a couple of minutes to come up with the final product. It was now time for the first flight. The test pilot held the mean machine from the rear bottom end and blew a couple of times into the tail, maybe that helped start the after burners, and launched it from the stage at the front of auditorium towards the double doors at the rear end along the center aisle. It flew straight and fast and must have reached Mach 2  by the time it was only 10 feet away from the door, and everybody was anticipating it would crash into the doors and gently fall to the floor, ready for the next flight. It was closing in at the furious speed of 2 ft./sec. towards the door when the doors suddenly flew open and in walks a human figure resembling the Terminator (Arnold Schwarzenegger) as the rear end of the room was at a higher level and the light source was behind the person creating a larger than life profile of the person entering the auditorium. The rocket plane hit him smug on the chest, executed a loop and made perfect landing on the floor.

"Kaka! come here!!" came the command and our aspirant Aeronautical Engineer jumped off the stage and briskly ran towards the Terminator. "Pick it up and come outside with me"… they both walked out with the plane in the potential engineer's hand. The doors were left open and by now we had our eyes adjusted to the light outside and we could make out that our friend was with the GSTO in the area between the Commandant's Office / Jetty and the Hilton  / Avionics block. "Fly it Now" came the orders and our friend thought it was a rhetoric command not meant to be carried out and stood still in proper attention position, chest out belly in and arms locked by the side and sweat starting to flow down the left side of his face. "I said fly it!!!" and it was clear by now that he actually wanted him to fly the plane. The jet was let loose into the steady ocean breeze and landed graciously after a couple of seconds of flight. "Fly it again" and off it went for another trip. "Keep doing that until I return…. and keep in mind I can see you from my office", and off went  Kaka to his office on the other side of H&S Department, while our friend honed his flying skills in the hot and bright sun, enjoying the freebie of dried fish smell from the neighboring Goth Ibrahim Haidri village.