Better access, more breathing room: A coach shares what’s working in primary care

Making the shift to Primary Care Access Improvement

The challenge is finding the time, structure and support to turn that knowledge into lasting change.

That’s where the Primary Care Access Improvement program (PCAI) comes in. Over 18 months, participating teams receive expert coaching, seed funding and a network of peers working toward the same goal: improving timely access to primary care.

Through PCAI, teams put Advanced Access into practice — an approach that balances appointment availability to patient need, so that people are seen at the right time by the right person. The approach has been used in primary care practices across Canada, with examples showing shorter waits for appointments, more appointments available within 48 hours and better experiences for providers, including reduced workload and greater work satisfaction.

To understand what that journey looks like, we spoke with Isabelle Gaboury, the lead quality improvement coach currently guiding teams through PCAI's first cohort. A researcher and methodologist by training, Isabelle works directly with clinic teams and has coached more than 60 practices across Canada, refining the approach alongside each team.

Clinics often look for a specific formula when trying to improve access. Why doesn't Advanced Access work that way? 

Isabelle: We know a great deal about what works, but there is no single formula. Think about baking a cake. You know the ingredients, but my oven might need 425 degrees and yours might need 375. There will always be some adaptation so the cake turns out just as well at your place as at mine. 

That is especially true in primary care. Moving from one province to another, the policies differ, interprofessional teams are structured differently and the scope of work is not the same. So we do not hand teams a recipe. We work it out with them. 

What role does data play in a coaching session when a team is applying Advanced Access? 

Isabelle: Every meeting, we look at the data together and see what worked from the changes we agreed to test, what did not, and why. 

Recently, I was working with a team on their no-show data — the percentage of booked appointments where patients don’t attend. Teams often estimate their rate as higher than it is, so I expected that here. In fact, this clinic was averaging around 12 percent. We are happy below 2 percent and beyond 4 we encourage teams to act. Seeing that number together told us exactly where to start, because an appointment you know will be a no-show is an appointment another patient cannot have. 

Advanced Access is about the right patient, at the right time, with the right professional. A patient with an urgent problem who is seen too late is four times more likely to come back for the same episode of care, and the same is true if they are not seen by their usual provider. Manage the schedule so that visit happens at the right moment, and you avoid the second one. 

Improvement takes time, but primary care teams are already busy. What does the commitment look like for a team participating in PCAI? 

Isabelle: We start with a session that brings the whole clinic together, about two hours, with everyone in the room. Admin staff, every professional. We want to hear how access is experienced from every vantage point, because identifying the problem carefully is what makes it possible to solve. 

From there the clinic identifies an improvement team of four or five people: a clinical lead (physician or nurse practitioner), a nurse, someone from admin, often the manager. That team meets with their coach for 30 minutes every two to three weeks, with data in front of them each time. 

Making an improvement is one thing — sustaining it is another. Some of the earliest clinics you first coached are still seeing results years later. What makes the changes stick? 

Isabelle: We recently looked at three clinics we worked with in the early years, six or seven years on. They had gone from real challenges with access to becoming model clinics, and they are still working well today. I remember getting their numbers and calling my colleague, because it was so emotional to see. 

What we have learned is that the changes which last are rarely the ones a team makes quickly and then leaves alone. A classic mistake in quality improvement is to make a change, see some early success before you are really finished, and open the champagne. Roughly half the work is making sure the change is sustainable. Part of our job as coaches is to say, you are not done with your push-ups yet — there are a few more to do if you want the muscles. 

It also helps that we treat access as a whole system rather than a checklist. Changing one thing affects another, so we work with each team on how the pieces fit together and at what pace. Some changes are straightforward to hold onto, like not opening your schedule too far in advance, or offering more than one way to book an appointment. Others need a bit more support before they become simply how the clinic works. 

What makes it last, in the end, is that the team built it. They know what it took, they know what going back would mean, and they do not want to.  

Improving access is ultimately about patients, but you’ve also seen a difference for the people delivering care. What does success feel like for a team? 

Isabelle: The line I will always remember from a clinic staff member is, "you give me some air." They felt in control of their schedule again. 

For clinicians, it means the end of fit-ins - the five patients added after your day is technically over because they genuinely need to be seen. It also means taking vacation without spending the month after you return rebalancing supply and demand. 

You see it just as clearly at the front desk. In one clinic, the phones rang from nine to five and everyone was frustrated. We worked on the schedules, the booking tool and several things at once. Then one morning the phone did not ring for ten minutes and the staff thought the line was broken. It was not. Patients simply no longer had to call back three or four times. One effect we see from that shift is less turnover among admin staff, because they are no longer absorbing that friction every day. 

And what does better access look like from a patient’s perspective? Do they notice the difference? 

Isabelle: They do, and often the first sign is surprise. Patients call and find they can be seen the same day, when they had braced themselves to wait. They are no longer calling every morning for a month to get in with their own physician.  

Continuity improves too. Because the schedule is built around seeing the right patient at the right time with the right professional, more people see their own provider rather than whoever happens to be free, and someone who sees their usual provider is far less likely to be back for the same problem. Over time, that becomes a confidence that the clinic will be there when something comes up.  

One of our coaches was at a training course, talking with someone from a completely different industry during a break. That person started describing her own clinic — how the staff ask a few questions and always find her a spot, how she never waits. 

When our coach asked where the clinic was, it turned out to be one of the clinics we had worked with. We brought that straight back to the team, and it travelled around the clinic all week. That is what patients remember. 

For a primary care team that wants to improve access but isn’t sure whether PCAI is right for them, what would you want them to know? 

Isabelle: Most of the clinicians I meet want better access and simply do not know what to do next. That is what we work out together. 

The size of the clinic does not matter, and neither does whether you are a teaching practice. Sometimes it is just a bigger ship to turn, but it is feasible. If you are willing to test solutions and try something different, there will be successes. And, we are not only here to improve access. We are here to improve your team's quality of life. 

Ready to make the shift? Applications for PCAI close on September 9, 2026. Visit the PCAI program page to learn more. 

About Isabelle Gaboury 

Isabelle Gaboury, PhD is a full professor at the Université de Sherbrooke and a trained improvement coach and advisor. A biostatistician and methodologist by background, she has spent her career applying quality improvement methods to primary care. With her colleague Mylaine Breton, an expert in Advanced Access, she began coaching a small group of clinics in 2019, that work now supports teams across Canada. She currently coaches teams in PCAI's first cohort.