When it comes to managing patient flow, most practices could take a few cues from the House of Mouse. Despite the tens of thousands of visitors who flock to Disney World on a daily basis, the world's most popular theme park is uniquely adept at funneling patrons into the gate, through the elaborate maze of rides, and past the parade route with nary a bottleneck in sight. "You have to think about your practice as if it were a ride at Disney World," suggests Murray Cote, associate professor and director at Texas A&M's Health Science Center. "They're very deliberate about where you go in and where you go out. You have a clear point of entry, they move you through the line where they provide entertainment while you wait, and they dump you out at the end. The people coming in never see the people going out." A similar efficiency should be the goal of every private practice, he says.
Indeed, for all the metrics that medical offices use to benchmark performance, it's patient flow that may be the most accurate measure of productivity, says L. Gordon Moore, a former family medicine physician and current director of clinical transformation for healthcare consulting firm Treo Solutions in Albany, N.Y. The ability to move patients from door to doctor with minimal delay, he says, enables practices to increase volume without sacrificing quality of care. But it also helps practices deliver a more positive patient experience by decreasing wait times and giving doctors more time to complete exams. And that, says Moore, makes patients more likely to adhere to treatment regimens and keep their follow-up appointments. "The importance of this goes well beyond any financial indicator, to how well we help our patients achieve good outcomes," he says.
The goal of patient flow, of course, is to strike a balance that keeps your exam rooms full and your wait times to a reasonable limit — a task easier said than done. Though the formula is different for every practice, the Institute for Healthcare Improvement says you know you've got it right when the providers in your practice are consistently in a position to move through the schedule from one room to the next without waiting for a patient to be roomed. Another good sign? Wait times of 15 minutes or less. "People, in general, don't get too cranky with waits up to 15 minutes, but it is possible to get below five minutes if your flow is exceptionally good," Moore says.
Perform a diagnostic
Before you can effect change, however, you must first review your internal systems to determine where any problem areas might lie. If you're willing to spend the bucks, you can hire a consulting firm to do it for you. A patient flow study essentially tracks who did what to whom and for how long. They also identify "down time" for clients and staff, the number of interruptions that create delays and opportunities to improve efficiencies in the patient visit. But you can take the pulse of your own practice easily enough on your own. "You generally don't need to go out and get a consultant," says Moore. "Some of the ideas [for flow improvement] are pretty obvious."
For example, Moore suggests asking the patients you serve for their take on the office experience. That can be accomplished either verbally in the exam room or by a short, written survey. In either case, ask them the degree to which they believe the office is well organized, how long they had to wait, what they like about your practice, and what they would like to see change, he says.
It's also important to get input from your staff on how patient flow in their work space can be improved, says Moore — and to follow up with a test run that quantifies how long it takes to move patients through the practice. "Walk through the practice as if you were a patient, jotting down what you observe," he says. "Where do we see confusion or bottlenecks?"
The results may surprise you. According to Cote, one "busy primary-care practice" he worked with complained that they fell behind each day because most of their patients showed up late for their appointments. "We studied it for over three weeks and we found that on average their patients were actually seven minutes early," he says. "It was a case of the practice not being as on time as they should be. The patients were there, but the staff wasn't ready to process them."
Ultimately, practices identify inefficiencies using the same skill set that a physician would use for making a clinical diagnosis — by asking questions, says Steven Chinn, a consultant with Joint Commission Resources, an affiliate of the non-profit Joint Commission, which is focused on patient safety and quality care. How often do inefficiencies happen and what's the magnitude of the effect they have on the practice? If your last patient leaves at 5 p.m., why are your doctors still there at 8 p.m? Is it due to poor scheduling? Are you trying to do too much, or are you not leaving enough time for the unexpected? "Those are all different fixes," says Chinn, noting the practice where he previously worked blocked out half an hour every day for unexpected walk-ins. "If your practice is prone to same-day emergency calls, build a buffer into your schedule so you can better plan."