Table 1 Ten key principles of ACA as assessed on the survey.

Work down the backlog (for example, by adding extra overbook slots to schedules, extending clinic hours, adding clinic sessions, reviewing wait list to see if medical needs could be met by phone call or other means)

Reduce demand (for example, by extending reappointment intervals, creating alternatives to face-to-face visits, and using referral guidelines)

Understand supply and demand (for example, by knowing how many appointment slots a clinic has, knowing what the provider panel size cap is, knowing how many patients come in, call in, or are scheduled each day for the clinic)

Reduce appointment types (for example, by reducing the number of separate clinic profiles, standardizing the length of appointments)

Plan for contingencies (for example, by anticipating and planning for situations like provider leaves and the annual flu vaccination season)

Manage the constraint (for example, by figuring out where the 'logjams' occur in your patient care process and figuring out actions to deal with them)

Optimize the care team (for example, by using standard protocols, matching patient needs to skills of appropriate team members, not necessarily always a physician)

Synchronize patient, provider and information (for example, by starting clinic on time, checking charts for completeness, accuracy and presence at appointment)

Predict and anticipate patient needs at the time of the appointment (for example, by using regular clinic team 'huddles' to communicate and deal with possible situations that may arise, using clinical reminders to get as much done in each visit as possible)

Optimize rooms and equipment (for example, by having the same supplies available in each exam room, making sure supplies are continuously stocked, using 'open' rooming)