Friday, February 29, 2008

Block Booking Example to Improve Patient Flow

Back on February 20th I wrote about the principals of block booking and why they control waiting. In a nutshell, blocking time for different patient groups ensures that everyone who needs an appointment wait’s the correct amount of time. As long as a clinic is using 80% of their time, you can only see one group of people quickly at the expense of others. So setting waiting goals is not only good for patient flow but it will improve patient satisfaction.

Today I’ll walk through an example. A clinic set guidelines for two sets of patients – those that require a skin lesion to be checked (Mole Group) and those that call in with sore joints (Joint Group). The clinic decides that the goal waits will be 10 days for the mole group and 20 days for the joint group.

Here are the steps to create the blocks:

Count how many people from each group are currently booked going forward
(appointment blocks are in bold)
Example: Joint 40 people, Mole 30 people
Count how many from each group have been seen in the last 30 days
Example: Joint 120 people, Mole 15 people
Calculate you completion rate (average number completed per day)
Example: Joint = 120/30=4 per day, Mole = 15/30=0.5 per day
Calculate Wait Time at Current Completion Rate = Booked/Completion Rate
Example: Joint = 40/4 = 10 days, Mole = 30/0.5 = 60 days
Calculated the number of appointment slots per day required to meet Wait Time standards
Example: Joint = 40/2 = 20 days, Mole = 30/3 = 10 days

In the schedule you need to block 2 appointments per day for people with joint pain and 3 per day for mole evaluation. Some of you may ask why I calculated the completion rate in Step 3. The reason is that there is going to be a change to the flow of patients in the clinic. The back staff may on be equipped to see one mole patient every 2 days. If they are going to be seeing 3 per day it may have an impact on what they need and/or how the set-up for this type of patient. Also, for these two groups of patients the number of reserved slots is increasing from an average of 4.5 per day to 5 per day. As long as 80% of the schedule is being booked these extra slots will have to come from another patient group.

If you’re clinic moves to block booking you also need to have a group of patients that could use more urgent appointments (short notice list). If a block has not been filled by ½ of the desired wait time (e.g. there is an open block for the mole group at 5 days and joint group at 10 days), fill it in with someone from the short notice list. The graph below is an example of how block booking dampened the amount of variation for a group of same day surgery patients (blocking started in early 2006).

For those clinics with more sophisticated technology (data mining techniques) other systems can be used to count the patients waiting or already treated and their mean wait times. In our clinic, the mean wait time is measured directly from the appointments (date of appointment – booked date) and the number of patients in the queue is also measured directly. Block booking will improve patient flow and satisfaction. It also let’s the clinic set and manage priorities in a very logical and planned fashion.


Suzanne said...

Interesting information. As an emergency department physician, I was always concerned about wait times.

System MD said...

Just need to add a Comment of support and surprise.
It seems obvious – to you, me and any operations expert – that Queueing theory and the Theory of Constraints have great applicability in the ER, the OR, the office, indeed all of health care delivery. While major modifications are absolutely necessary, those who who taken a systems thinking approach, like you, have seen great improvements for both patients and providers, not to mention payers.
My "surprise" is how few recognize the value or take the time to make it happen, particularly when someone like you has done most of the hard stuff.
Ideas, approaches, and experience from the [business] management world can help health care in a host of ways. All we need is open minds; willingness to change; and dialogue between health care providers and experts in management disciplines. Unfortunate how rare these things are.
Good luck and thanks for your hard work.
System MD []