Getting and maintaining control of the medical practice schedule has a bigger positive impact on resource utilization, profitability, and the general satisfaction of patients, physicians, and staff than almost anything else. Here are five elements of effective scheduling.
Industry standards for appointments and procedures can be very useful in identifying areas in which one medical practice is different from others. Arbitrarily scheduling according to industry standards, however, is not productive. For the purpose of scheduling a particular practitioner's day, industry guidelines are no more than interesting information. The germane question for scheduling Dr. Jones' day is "How long does a particular type of exam or procedure take Dr. Jones?"
Something similar is true relative to structuring schedules to produce a certain amount of gross revenue. All things being equal, increasing time-related capacity requires lengthening the clinic day. Shortening appointment allotments produces a schedule that only appears to be more productive. The day gets longer in an ad hoc manner, with all the frustration associated with consistently running behind.
The bottom line is that the work takes the time it takes. It is possible to decrease the time required by redesigning tasks and work flow, but scheduling to a more efficient environment needs to wait until the more efficient environment is more than a fond hope.
Build in lead times
Even if he is on time, or a little early, a patient with an 8:30 a.m. appointment will not be in an exam room waiting to be seen at 8:30 a.m. Depending upon practice processes, he may not be ready to be examined until 8:45 a.m. or 9 a.m. Knowing the lead times relative to different types of appointments allows the physician to correctly interpret the real (READ: for the physician) appointment time.
Plan on work-ins
It can feel good to look at the next day's schedule and see it booked solid because the promise is one of maximized resource utilization. Unfortunately, if all practice resources are committed, there is no slack available to respond to the unexpected. Protect specific times for same-day appointments. If the practice seldom has the need to work in a patient, the specific appointment times can be outside of the regular schedule, at the beginning of the lunch break or after the last appointment of the day. Other practices will find that one or two "work-in" slots within the regular schedule are almost always utilized.
If an analysis of practice activity reveals that an annual physical takes 28 minutes on average, scheduling appointments at 28-minute intervals is both intuitive and ill-advised. The problem is with the nature of the measure. Widely divergent data points produce an average that is between the two measures, but far from each. Variance is the statistical value that measures the disbursement of observations from the mean or average.
Depending upon your tolerance for running behind and your tolerance for waiting on patients, schedule appointments at the average time required plus one standard deviation to predictably finish two-thirds of exams within the allotted time, or the average time required plus two standard deviations to complete 95 percent of exams within the allotted period.
As much as possible, stay on time
Patients will adjust their appointment times to match what they expect from the practice. If a physician is often an hour late, the patient will consider herself on time if she arrives within an hour or so of the appointed time. If the physician's timeliness is sufficiently erratic, she'll consider herself timely if she appears on the scheduled day. The result is that the physician, on those occasions when he is running close to on time, will find himself waiting for patients to arrive. An added benefit to consistently running close to schedule is that providers and staff have to deal with fewer angry patients.
Getting and maintaining control of a clinic schedule pays huge dividends. What has worked for you? What seems to be an intractable challenge?
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