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Fishbones Popping Up in Primary Care Offices Across Champlain?

Improvement tools such as fishbone diagrams and process maps are making an appearance on office walls across the region as primary care physicians and nurse practitioners tackle improvement projects with the support of the Champlain Quality Practice Facilitators.

Here is a snapshot of the work underway by 16 physicians and 9 nurse practitioners currently enrolled in the program:

  • Eleven teams are working on projects related to improving efficiency in office processes. Most are working on improving appointment flow aimed at improved patient, provider and staff experience. Changes such as relocating printers to exam rooms to reduce steps and quick huddles to prepare the team (e.g. flag missing labs or reports) are showing early signs of success.
  • Seven providers are focused on reducing delays to appointments beginning with an analysis of their appointment supply and demand. They are testing changes to increase their supply and decrease demand such as: extending the return visit interval for appropriate patients, reducing no shows, and sharing the care with other team members to manage the load. Removing different appointment types from the schedule has simplified booking and reduced delays for appointments. Post vacation scheduling technique is a popular and successful change making the return from vacation a happier experience for all.
  • Four projects related to management of chronic conditions are underway. Shared decision-making between the physician and patients in the management of hypertension is the focus for one team. Another team of physicians and nurses is aiming to integrate the role of CDM nurses to share the care of patients with diabetes and increase cognitive and falls screening in older adults.
  • Two providers working on cancer screening began with mapping their processes to identify improvement opportunities. Identification of eligible patients (and exclusions) as well as involving members of the care team in the screening process are being tested. The Practice Facilitator connected this team with one of the Champlain Leads for Cancer Care Ontario who joined a meeting to offer information about using the new SAR with their EMR and shared other change ideas.

Stay tuned for project updates from participants in the Champlain Primary Care Quality Practice Facilitation Program.

More Information

Are you looking for support to improve an aspect of your practice? Still wondering what a fishbone diagram is?

Contact Ruth Dimopoulos, Quality Practice Facilitator, at 613-820-4922 ext. 3395 or by email at

The Champlain Quality Practice Facilitation Program is funded by the Champlain LHIN.

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