Despite their best efforts, or perhaps because of them, most physicians' offices perform well below what's achievable. For instance, the waiting time for both providers and patients can be menacing, staff efficiency is often low, communication and coordination of care are exhausting, and finances are usually strained.
Such a scenario can become the exception, rather than the rule, say the experts, with the application of a relatively new theory. All that is required to reap the rewards, they say, is steadfast faith and staunch commitment.
Mark Murray, MD, the self-proclaimed 'grandfather' of the application of the 'open access' or 'advanced access' theory in healthcare scheduling, began working on the process, along with colleague Catherine Tantau, in the late 1980s. In true advanced access, according to Murray, physicians schedule "today's work today," working with a daily schedule that is 75 percent open for the average family practice.
Murray estimates that 60 general and specialty practices around the United States are applying advanced-access scheduling with remarkable success. The idea — predict demand and hold capacity — works in just about every other industry but has been applied sparingly in healthcare for a number of reasons.
Build it and they will come
For one thing, it takes more than blind faith for most physicians to entirely scrap the way things have always been done. Physicians want information, education, tools, and evidence to support the promised rewards. But Murphy is cautious about looking for a single successful model. "Access improvement is all about principles — supply and demand, flow, capacity. Every organization is a little different. They apply the principles to their own sites. There is not some off-the-shelf product," he explains.
In other words, achieving 'same-day' access and nearly wait-free patient flow may be an individual decision. So ultimately, to demonstrate the rewards and sell others on the concept, someone needs to take the plunge.
David W. Wetherhold, MD, head of internal medicine at Scripps Clinic-Torrey Pines in California was the first to take the leap in his organization, a 300-physician, multi-site practice. And a leap it was indeed. Wetherhold read materials on the concept on a Thursday and by the following Monday he and another colleague had initiated an open-access system that allowed two same-day appointments daily.
Soon, they were able to fill other slots through cancelled appointments and no-shows. Time was also created by implementing standard advanced-access operations suggestions, such as converting sick visits to routine care, which eliminates the need for return visits for physicals and other yearly requirements, and using resources previously dedicated to 'triage' for telephone care, which can often replace return appointments.
In about six weeks, Wetherhold and his colleague each were working with only 40 percent to 50 percent of their schedules booked daily.
Dispelling the fears
Whittling down the backlog of appointments presents one scary aspect of open access. "It was hard putting aside an extra half-hour to hour for this thing that was supposedly going to happen," says Wetherhold. "But once I started doing that and saw the improvements I became a true believer." Not only did patients like it, but also fellow colleagues started taking notice.
Two by two, doctors all around Scripps Clinic began open access to achieve what Wetherhold notes as an average of 70 percent open schedule daily. Today, 95 percent of Scripps Internal Medicine physicians and 30 percent of the specialists use open-access scheduling.
Ultimately, Murray emphasizes, it comes down to changing the way you think and building the system according to what the patients want. There is security in having a schedule booked with 20 patients a day for the next two months. But those in the know insist an unbooked schedule can offer the same security.
"The biggest fear when I started was that I wouldn't have patients," acknowledges Allyn Norman, MD, of Tonawanda Medical Associates in Buffalo, N.Y. "But there has never been a time when I've been able to sit down and do paperwork in the middle of the day." But now, after integrating an advanced-access system, he deals with fewer rescheduled appointments and no-shows, and is actually seeing more patients than ever, he says. And he has more control over his schedule.