Most practices begin their day with the best intentions of managing their schedules. But many end up squeezing extra patients into an already busy schedule or need more time than allotted for scheduled patients. That results in bottlenecks, inefficiency, frustration, and patients kept waiting — either in the reception room or a small exam room, where time seems to move in slow motion.
Think of scheduling problems as a practice-wide issue, not one that just involves the schedulers or the providers. When the scheduling system doesn't work everyone is affected.
Resolving scheduling problems requires getting to the root cause of the problem. Sounds easy, but it's not. It takes time and dedication and typically no one in the practice has extra time. Just the same, the reality is if you don't take the time to clarify the problem, you can't find a plausible solution that will eliminate the bottlenecks, improve efficiency, and help you manage the day better.
1. Use data to identify trends.
Today there are tools to help you better understand specific scheduling and patient flow problems. Most electronic scheduling systems have the reporting capabilities to accurately track patients through the practice including: appointment times, arrival times, time to be roomed, time to be seen by physician, and when the patient's visit was completed.
By looking at two weeks of data, you will have sufficient information to identify trends and the root cause of your scheduling and patient-flow problems. This information is critical to digging deeper to evaluate specific incidences and determine what causes the bottlenecks and work-flow problems in your practice.
2. Establish a baseline.
Before you begin the analysis it is important to establish a baseline for what you consider to be "on schedule." I would suggest you are behind schedule if there is a delay of 15 minutes between a patient's scheduled appointment time and when the physician enters the treatment room. That may seem unreasonable, but wait time is a major factor in understanding whether a practice's work flow is efficient, space is well utilized, or patient service is compromised.
Start by looking at the scheduling patterns revealed in the daily patient-flow report to determine:
• The total length of time each patient was in the office, compared to the length of the appointment.
• How many patients were booked within the last 24 hours before their visit?
• How many of those patients were double-booked?
• Where you fell behind schedule (and why).
3. Adjust the schedule to ease work-flow jams.
This may reveal a number of reasons for problems in work flow that aren't that difficult to fix. Perhaps you are clustering new-patient visits and efficiency could be gained simply by spreading them out throughout the day, scheduling only one new patient per hour. It could be that some patients need diagnostic studies during their visit and the appointment time is not adjusted to allow for this extra time. Maybe some providers need a little more time than others to complete the electronic-visit document, or maybe some physicians just never seem to start on time. In these situations it is important to schedule realistically based on the time needs of the providers.
Then, of course, there are some patients who just take more time. But in reality, this might be predictable. If so, you can improve the scheduling template to allow for some longer slots for patients with multiple care issues. Efficiency can also be improved if nurses are trained to take on more clinical-support responsibilities through well-designed protocols. This will enable the physicians to stay on time by delegating more tasks — including patient instructions for taking medications or post-visit care. Many scheduling and work flow problems can be resolved with a little effort and a team commitment.
4. Get a handle on double booking.
A more daunting problem is the practice that consistently struggles with more demand than scheduling parameters can meet, resulting in the need for double-booking — a dreaded nuisance that seems guaranteed to sabotage the schedule. Ignoring this demand compromises efficiency and customer service. If double-booking means adding just a few patients a day, this can be handled creatively and keep you on schedule. Simply schedule the work-in patient alongside a new patient visit. This allows the physician to see the add-on while the nurse is working up the new patient. On the other hand, if demand in the practice results in a need to double-book patients excessively, it's time to look for long-term solutions.
Before implementing changes to the current scheduling system it is wise to conduct a staff-provider workshop to discuss the root cause of your scheduling problems, and work as a team to find the best solutions based on specific practice needs.
* For a list of nine ways to improve your patient scheduling visit Nine Scheduling Techniques to Improve Patient Workflow.