Tuesday, April 22, 2008

Office Schedule Types Part 2

In what is likely to become a recurring post I’ve added to the list of appointment scheduling types. Some, like the wave, modified wave and batch refer to the way that patients are booked during the day. Others, like first-come first-serve and block refer to how appointments are allocated on a weekly, monthly or seasonal basis.

Mixed Clinic: The standard booking type where patients requiring different types of appointments are booked throughout the day and each given the amount of time they need for their appointment type.
My Opinion: It’s the standard scheduling type and difficult to argue against. Every clinic has short comings in staffing, size, patient mix and patient load that limit the utility of this scheduling type. So other strategies are almost always used in addition to mixed clinic. Usually it is mixed with block booking to control wait times.

Batch Clinic: Patients of the same type are booked one after the other. An example is several operative procedures one after the other.
My Opinion: We’ve found that there is no wait time advantage conferred by batch vs. mixed clinic. Where the clinic is larger and moving from room to room can cause wasted time there can be an advantage. It offers an advantage where an interval of time needs to be tightly controlled such as with safety concerns (sedated patient that cannot be left) or times where patients will feel especially vulnerable (e.g. from the time you ask a patient to get undressed to the time you see them).

Proportional: Similar to mixed clinical expect that patient appointments are classified into short, intermediate and long rather than appointment type.
My Opinion: The effect day to day is similar to mixed clinical but easier to use for staff. However, it precludes the use of block booking because patient type is ignored.

Wave: Patients are booked each 1/2hour (or hour) and all told to arrive at the same time.
My Opinion: An efficiency killer. Although 100% of provider time is used staffing and resources must be geared toward managing the start of the wave. Also creates increased wait for patients. It can be useful in short duration (7-10min) appointments with longer set up times and high variation between cases (eg 5 min vs 10min is 100% variation). A good example where this would be useful is an operative procedure like myingotomy and tubes.

Modified Wave: Same as wave with an open slot every 5th appointment to “catch-up”. For instance 5 patients are booked every 60minutes with an open slot at the end. Patients are told to arrive on the
My Opinion: With similar appointment lengths (exactly 15min each) should work well but can work just as well with normal scheduling and greater efficiency in theory. The same exception of short duration, high variation appointments still applies.

Open-Access: The entire schedule is left open for any patient to book any time. Similar to first-come, first-serve except that an excess of time slots are available to keep wait times at 0-2 days. There is no wait time for appointments and any patient can book at any time.
My Opinion: As long as a clinic can maintain extra appointment slots and low variation in the time required for appointments this scheduling type has the lowest wait times. For longer appointments or when preparation is required such as in procedures it can be used together with another booking type. There will be an upcoming special post on open-access in the next month.

First-come First-serve: It doesn't matter what the patient is calling in for they are given the next available appointment with whatever time is required. The schedule is left open and any type of appointment can be booked at any time of the day.
My Opinion: In a practice with low patient mix this schedule will work well but whenever the appointment types vary the result will be to cause longer waits for longer appointments.

Priority Queue: First-come, First-serve is still used but certain patients are given priority over others. Think of waiting for hold at a large corporation. If you press a certain number you'll be put in a line that will move faster.
My Opinion: Priority queuing is necessary to use block booking. I favor block booking with priority queuing for different types of procedures and appointment types.

Block Booking: Where parts of the day are reserved for different types of patients. For instance 3 hours is booked for diabetes follow-up, 1 hour for hypertension patients, etc....
My Opinion: In a clinic with a lot of different types of patients (e.g. general clinic vs specialist office) this method maximizes patient satisfaction. There are two important limitations: a) utilization of the clinic is high (eg. high wait times, few open appointments) b) organization is mature – it requires monitoring of the appointment times and waits then organizing days to match.

1 comment:

Anonymous said...

we use a combination of block booking with "openaccess" or same day booking for urgent cases. wait time is about 2 weeks for an appointment with 2 doctors in a single family practice clinic in florida.