Monday, March 17, 2008

Five Ideas: The Doctors to Get Patients an Appointment Faster

Here are five ideas for the doctors/providers to decrease how long people wait to get an appointment. I’ll be doing a series of entries in the coming weeks with ideas directed to doctors/providers, front desk (administrative staff) and clinic staff. Each entry will either help get appointments sooner, keep people waiting in the office less or improve efficiencies. The first entry is for doctors/providers to get appointments faster.

Here are the ideas:
1. Work: A major determinant of patient wait is doctor availability. Try matching days worked to seasonal variation in wait. In our practice the end of August is busy so we put a “moratorium” among the doctors on vacations. We also monitor wait by yearly quarters and try to match days between our offices. “Doctor Days” is the easiest measure but it can be hours, weeks or some other time frame. All wait times and other measures of efficiency are taken in the context of days worked. For instance our wait time went up 10% but our doctor days went down 15%. There is a net improvement in efficiency of 5%. I have also seen doctor days go up 20%, wait times remain unchanged and efficiency drop 20% meaning the extra days where literally useless (this can happen when the clinic is still underutilized). Days worked must be monitored to make any sense of efficiency and wait times. Have someone start recording doctor days on a monthly basis.

2. Set acceptable wait times and monitor: In my entry on block booking I described setting goals for different patient types. The provider and staff have to decide what an acceptable wait is. In a busy clinic it is important not to see clients too soon. It sounds counter intuitive but time saved with one patient can be spent with another so if you delay seeing one patient for a reasonable amount of time you can get another one an appointment in an acceptable amount of time. For instance an asthma exacerbation and sore knee. Neither wants to wait but from a clinical perspective if you let the knee wait a bit longer you can get the asthma patient in sooner. Take two actions: a) start monitoring wait times b) set ideal waits for major patient groups.

3. Don’t see more consults than you can do procedures: The concept that time saved with one patient can be spent with another applies to this suggestion. I sometimes meet clinicians that are procedure oriented who have no balance between the number of consultations they do and procedures they complete. If for instance, you can only do 5 procedures per day and you have 80% follow-through from consultation to procedure, you should see an average of 5 divided by .80 = 6.25 consults per day (6 for 3 days and 7 the 4th day). Seeing more than that does not help the patient get the procedure and fills time that could be spent elsewhere. Count the number of procedures & consultations in a week and see if they match.

4. Single day consult/surgery: I’ve done an entire entry on this under phone screening. If the clinic is geared towards completing a procedure on the same day it can save time for the clinic and improve patient satisfaction by completing it the same day. Look through minor procedures that are done in the clinic and determine if any can be condensed into a single day appointment with either better phone screen or improved organization.

5. Whole Day Blocks: Some times you simply can’t catch up. This is common with seasonal work loads or in group practices when one/many providers take vacation. If you are monitoring wait times by different patient groups and an isolated block of patients are waiting much too long dedicate an afternoon/day to just that patient group. It goes against the one-piece work flow idea but sometimes resources need to be temporarily reassigned. This is where practicality sometimes runs into a wall with Lean advocates. The argument is that reassigning resources in this manner disrupts work flow; increases variation and decreases efficiency which ultimately increases wait times. My argument is that if the reallocation is measured, proportionate and limited it quickly corrects and in-efficiency. It will not work unless you are using block booking (if you are not using block booking all patient wait longer not just the one group). Look for one patient group at one time of year and plan an entire day to deal with the work.

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