June 12, 2019
A well-constructed schedule improves patient flow, minimizes wait times, and increases patient and provider satisfaction. The smoothest running clinics are the ones that know how to control the schedule. They don’t let the schedule control them.
Good scheduling is more of an art than a science. Perhaps you have tried revising the scheduling system before, but it didn’t work. The staff reverted back to the same, short appointment slots and chaos again ensued. Don’t view this as a failure. Instead, look at as a worthwhile exercise in how you might do things differently.
We’ve improved the schedules, patient access, and physician stress levels in many practices by restructuring the appointment schedule and creating templates that work.
Here are some of the steps we take to maximize productivity and patient flow.
1. Outline your goals.
The overarching goal, of course, is to create a schedule that is efficient, supports good patient access, and maintains a smooth patient flow. But you need to set more detailed goals. How many patients should each physician and provider see each day? How many new versus established? Is there a target number of consults each physician wants, so he or she can fill their block time?
And what about start times for each clinic? What are they and what does that mean for staff scheduling and patient prep? If a provider is scheduled to begin the day at 8 a.m., patients must be ready to be seen at 8 a.m., not 8:20 a.m. or 8:40 a.m.
Pull all these goals for each physician and provider into a spreadsheet so you have them all in one place and can easily refer to them as you proceed through an analysis of the schedule.
2. Track and analyze patient flow for one week, for each provider.
Identify where weaknesses in the schedule currently exist. For instance, back-to-back complicated visits that slowed down the physician, or back-to-back simple visits that created down time.
Determine if your practice management system can track patient times. If not, print the schedule and ask the nurses write down the time the physician enters and leaves the room for each patient.
3. Based on results of the tracking and analysis, establish appointment types and appropriate lengths.
Do this by defining the most common types of appointments, for example:
• New patient, complex (45 minutes)
• New patient, other (30 minutes)
• Recheck, simple (10 minutes)
• Recheck, complex (15 minutes)
• MRI results (30 minutes)
So, you could schedule an established patient, new problem as a new patient appointment. The idea is to break down the generalized appointment reasons and the average time spent per patient.
4. Determine what an ideal, efficient session looks like.
How many of each type of appointment should be seen per session? How are the complex appointments spaced out? (I.e., new patients are seen on the hour and follow-ups are seen on the half-hour). Keep in mind that if there are three or four providers in the office during the day and they all start with new patients, there will be a bottleneck at the front desk, as well as in the X-ray area.
To reduce the bottleneck in the X-ray area, make sure the schedule spaces out patients who may need a radiograph. Do this by thinking through which types of patients need to be in each available exam room. For example, at 8 a.m., a postoperative patient who does not need a radiograph can be ready and waiting in exam room 1, while the nurse in exam room 2 preps a new patient.
5. If you offer X-ray, consider creating an X-ray schedule.
Having an X-ray schedule helps reduce bottlenecks that inevitably occur. Schedule patients who need an X-ray based on standing orders – first with X-ray, and then with the physician. Consider leaving prime time appointment slots, such as first thing in the morning, around lunch, and at the end of the day for working, non-Medicare patients.
Once you’ve got the information from these steps sorted out, build the goals, time lengths, visit types, and X-ray schedule into scheduling templates in the practice management system. Structuring the templates to match the “ideal state” of the schedule as you’ve defined it as a result of this analysis, and using color-coding to designate visit types and length will support schedulers to follow the guidelines with fewer errors.
Make a Plan for Proactive Patient Collections in 2019