May 28, 2019
“The schedule fills so quickly with follow ups that I struggle to find time to book consults. And then the surgeon is unhappy if there is unused OR time. Help!” This was a recent conversation with a Patient Care Coordinator (PCC) in distress about the lack of available consultation time.
The practice did not utilize precision template scheduling, though their sophisticated practice management system offered the feature. Instead, staff used loose scheduling guidelines – that were written on a cheat sheet – to place appointments where they fit.
The PCC understood her primary responsibility was to keep the surgery schedule filled, yet the overfilled clinic schedule forced her to “work in” consults by overbooking. The result was long wait times and frustrated patients, doctor, and staff.
If this scenario is all too familiar, consider these tips for creating a precision schedule template to optimize clinic scheduling.
1. First, determine the types of appointments you want to see.
When considering the schedule template, it’s a good time for surgeons to reflect on the desirable mix of the practice. For example, Dr. Joseph Mlakar, a plastic surgeon in solo practice in Fort Wayne, Indiana, established four categories: Passions, Politics, Pay Dirt, and Plugs.
• Passions: For Dr. Mlakar, a fellowship trained craniofacial surgeon, taking care of children born with a cleft lip or palate fulfills his life’s purpose. In addition, he finds breast reconstruction a rewarding line of work. His passion for these procedures outweighs the less-than-desirable reimbursement by most payors.
• Politics: In Fort Wayne, the local hospitals require all surgeons with privileges to participate in the EMTALA call schedule; treating patients seen through the Emergency Department while Dr. Mlakar is on-call is an example of this category.
• Pay Dirt: Generally speaking, these are aesthetic surgeries that are the most profitable use of his time. Dr. Mlakar genuinely enjoys the art of aesthetic surgery, and the larger margins provide income to sustain the lesser reimbursed cleft surgeries.
• Plugs: These are “everything else” that fills in the schedule – pre-ops, post-ops, and follow ups.
Dr. Mlakar explained that an unanticipated result of categorizing his work was realizing the things that did not belong on the schedule, such as hidradenitis and pilonidal cysts. He didn’t necessarily enjoy the cases, there wasn’t a political reason to do them, and the surgeries were often poorly reimbursed. His practice had reached a level of business and maturity that these procedures no longer fit into the mix.
2. Prioritize consults.
Starting with the end in mind, determine how much OR time needs filled, consider your average Patient Acceptance Rate, and establish the number of consultations needed to fill the time. Then, create appointment blocks that are reserved exclusively for consults. From there, create slots for pre-ops, then post-ops, and finally follow ups.
3. Design the schedule with the surgeon (or provider) as the rate-limiting factor.
Let’s all agree that a surgeon standing around without a patient to see is problematic for everyone. Build the schedule with an understanding of how much time the surgeon spends with the patient while also considering the time staff spend with them.
For example, if a patient spends the first 15 minutes of a consultation with the PCC reviewing his or her surgical goals and medical history, the surgeon can see a post-op or follow up patient at the same time. This is not the same as randomly double-booking; it is a thoughtfully designed clinical flow that allows maximum efficiency and minimal patient wait time.
4. Build the template into the practice management system.
This might seem obvious to some, but too many practice skip this step. We endorse precision templates that: make it visually obvious where to put appointments; enable the staff to utilize the function to search for next available appointment by type; and overall make scheduling practically foolproof.
An example of a precision template for a morning looks like this:
5. Leverage the staff as an extension of the surgeon.
Mlakar advises, “Be the conductor, not the orchestra.” Delegating permissible functions to support staff optimizes their roles and keeps the surgeon moving in clinic.
An example of this is asking the PCC or medical assistant to document the clinical note while chaperoning the surgeon. The staff member records the details of the exam and discussion, allowing the surgeon to fully engage with the patient rather than the computer. An added bonus is minimal documentation required by the surgeon to complete the note. “It took me several years to figure this out,” said Dr. Mlakar, “but now that my staff record most of the visit, I can quickly add a few details to the note and sign it. I no longer spend hours dictating, and my notes are done before I leave the office.”
6. Re-assess and re-adjust regularly.
It is unlikely that your first attempt at creating a template will be perfect. What looks good on paper (or computer screen) may not translate flawlessly to real life. Don’t give up! Tweak the schedule and make adjustments, engaging all members of the staff for feedback. As the practice matures, expect the template to evolve as well.