February 19, 2019
Many people in your office have access to the appointment schedule. But who really “owns” it? Who is responsible for making sure it goes off without a hitch every day?
If the answer is “no one,” you need a Schedule Czarina. Someone who is empowered to review the schedule at least two or three days in advance (one week is ideal) and point out, for example, that next Tuesday is a train wreck. Then take action to fix it. Someone who handles the situation when the physician is in the exam room too long, or the nurse’s favorite rep arrives with bagels and risks derailing an otherwise on-time clinic.
One of our clients has a Schedule Czarina who is worth her weight in gold. She reviews the schedule days in advance as well as throughout the clinic. She handles cancellations, reschedules appointments, and works in the ‘first call’ patients from the cancellation list or who need immediate attention. All of the actions taken are based on protocols set by the surgeon.
Every practice needs a Schedule Czarina to tame their time thieves. When you appoint yours, be sure you give her the authority to ask everyone (surgeon included), “Hey! Why did you schedule this patient like this? You know we can’t do back to back consults on Wednesday; we’ll never stay on time…”
Here are some solutions that work for common time thieves. Hand them off to the Schedule Czarina and let her get to work.
1. The physician is not in the office at the start of clinic.
If the physician is often late, never start the day with a new patient. Instead, schedule uncomplicated, quick follow ups for the first three appointment slots of each day. Schedule new patients in the next scheduling wave, after the surgeon and nurse have their groove on.
2. Reps drop in unannounced.
Ask reps to schedule an appointment, and gently turn them away if they just “drop in.” (Even if they come bearing food.) I realize this is easier said than done if you have a leniency policy that has cultivated this bad time management behavior. Tap your Schedule Czarina for ideas on how to manage the mentality migration from “drop in” to “schedule an appointment.”
3. “This will only take a minute” syndrome.
Work as a team to keep the physician focused. Don’t knock on the exam room door unless it’s an emergency. Take messages for non-urgent calls. Insist that neurotoxin injection appointments be scheduled, not “drop-ins.” When you agree to see patients on a walk-in basis it’s disrespectful to the patient who actually thought to call ahead, organize their life, and make an appointment. Pretty quickly those in your reception area will begin to say to themselves: “Why bother to call and schedule when I can just show up?”
And in the case of injections, the physician is adding fuel to the fire by saying, “Well, it only takes a minute for me to inject…” Actually, if you set a timer from start to finish you’ll realize that it actually does not take a minute. It takes about 12-15 minutes before all is said and done. Do that once or twice each clinic and you will be running behind.
4. Patient adds issues to the visit.
Establish boundaries and train staff to confidently adhere to them. And attention surgeons: don’t undermine the staff by caving in to the patient.
We find the use of a scripted response works well for this. And you must practice it! Here’s an example…
“These are great questions, Ms. Jones. Once we address the concerns you initially mentioned, I’ll be happy to answer them. We may need to schedule another visit to cover them…”
5. Too many follow up visits.
Review the number of follow-ups for each procedure type and carefully consider how many are truly required for each. The surgeon may not even be aware that staff is scheduling as many post-ops as they are.
In many cases we find that the number of follow-ups can be reduced, adding more time back into the schedule.
6. EHR documentation is bogging things down.
This is a tricky one. One solution becoming more common is employing an EHR scribe to help the physician stay on time, and free him or her up for one-on-one focus with the patient. Scribes document the visit at the direction of the physician, while he or she performs a history and exam. At the end of the visit, the note is ready for physician review and signature.
Others leverage the clinical knowledge of one of the practice’s medical assistants, directing him or her to click while the physician conducts the examination and medical decision-making. The surgeon enters his or her documentation after the patient heads to the patient care coordinator, or at the end of clinic.
7. Patients call in the morning with problems that need to be seen.
This is a regular occurrence in a surgeon’s office. You know that. So plan for it, and always leave at least two open slots per clinic for work-ins and complications.