2 | Optimizing your workflow to improve access and attachment

This reference guide from the Alliance for Healthier Communities (2025) pulls together strategies and tips that can support your organization’s efforts to advance efficiency in order to improve access to care. It is divided into three main streams: 

• Balancing supply and demand
• Dealing with backlog
• Increasing operational efficiency. 

Within each of these, there are a number of strategies to choose from; each strategy is supported by suggested measurement and improvement activities and links to tools.

Although this document draws from a diverse selection of resources, it is most deeply grounded in the Advanced Access and Efficiency Workbook published by Health Quality Ontario in 2011. That workbook was created for organizations working towards implementation of Advanced Access in their organizations. It describes Advanced Access in detail and walks organizations through the process of looking critically at their current processes, measuring their population’s needs and their capacity to meet them, and finding ways to align needs and capacity by finding operational and practice efficiencies. The workbook includes interactive pages on which to record data as well as reference tables that connect the dots between efficiency principles, change ideas, and actions. Links to those pages and reference tables can be found throughout this document. 

This guide does not need to be read from end to end or used in a linear fashion. Links on the first page let you jump to whichever topic you think is most relevant to your team’s needs and goals. At the bottom of each page, you’ll find a “Return to Beginning” link that will bring you back to the first page. 

• Advanced Access and Efficiency Workbook for Primary Care (HQO) - see especially the table "Summary of Advanced Access and Efficiency Measures" in section 4.
• A Guide to Advanced Access and Efficiency for Primary Care Providers: Time For Change Module 3 (HQO and MacHealth) 

In 2022, the Essex County Nurse Practitioner—Led Clinic (NPLC) was facing challenges related to staff morale,  job satisfaction, and employee retention issues. In response their board and leadership made a commitment to enhanving staff and clinician wellness by providing a safe, inclusive, and respectful workplace; fostering opportunities for learning and teaching; developing positive and collaborative relationships; and promoting work-life balance.

To help them meet this commitment, they joined Health Care Excellence Canada's Health Workforce Innovation Challenge, which helps organizations experiment with innovations to enhance workforce retention and support.

Through in-depth collaboration with staff, they implemented several innovations, including:

• Introducing flexible work schedules
• Implementing remote work options, taking advantage of virtual care and related tools
• Reducing administrative burden with AI tools and other technology tools
• Empowering interprofessional staff to work at their full scope of practice
• Establishing a wellness committee with designated Wellness Champions at each of their sites
• Group activities such as themed lunches, staff walks, participation in community events,

To evaluate the impact of these changes, they quantified staff satisfaction at baseline and at the end of the challenge, using proxy measures such as sick leave utilization and retention rates as well as staff wellness survey scores. After completion of the challenge, sick time utilization was down; retention rates were up and survey scores were up. The results are showcased in this infographic. 

Testimonials from staff and clients have provided further evidence of improved staff engagement, efficiency, and access to care.

For more ideas and tools to support clinician and staff wellness and workforce retention, check out Chapter 4: Health human resources.

This report describes how the Merrickville District Community Health Centre (now part of Rideau Community Health Services) provided rapid access to team-based primary health care for thousands of patients who had been "orphaned" by the loss of three family physicians in Smiths Falls.

Some of the changes they implemented: 

• Implementing group medical visits.
• Moving clients towards self-management.
• Building a collaborative multi-disciplinary primary health care team.
• Collecting and reviewing data to measure impact of changes. 

Key enabling principles:

• Responsiveness to individual and community needs.
• Working collaboratively.
• Integrating with other services.
• Engaging clients to be active participants in their care.  .

Through these efforts, the CHC made primary health care services available to those most in need in ways that benefited not only those individuals but the whole community and the health care system. Benefits included: 

• High attendance and client satisfaction scores at group medical visits.
• Fewer emergency department visits and medication errors.
• Increased number of people with access to a primary health care provider.

Appendix A in this document and this 2011 news article provide additional details.

Staff at London InterCommunity Health Centre (LIHC) developed a collaborative exercise to measure the complexity of their clinical clients. This allowed them to rebalance their clinicians' rosters, ensuring balanced workloads. In this Lunch 'n' Learn webinar, LIHC staff described the project and provided an in-depth look at their methodology.

Given the high complexity of health needs among our sector's clients and the capacity crisis facing the health system, your organization may wish to embark on a similar process. This detailed case study from LIHC can provide inspiration and help you get started.  

Please note that while undertaking a similar complexity project may be useful for your team, many elements of the work at LIHC are tailored to that organization. You will need to work closely with your clinical, data management, and administrative teams to develop a tailored process that meets your organization's, clients', and community's needs.

The team from LIHC have generously shared the additional resources listed below. These will give you a deeper understanding of their process and may provide a helpful starting-point for your own complexity project.

• Overview of the LIHC complexity project. This high-level overview was presented at the Alliance's November 6 Professional Learning Event.
• Project Methods document. This includes the factors list and appendices with the LIHC team's ENCODE list, weighting tool, and detailed process-tracking.
• Sample Practice Profile. This vetted dashboard-style document shows detailed complexity data for an individual provider, including a list of the most complex clients, factors contributing the most complexity, and contextual information about the provider's organization.